stress health effects essay

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The impact of stress on body function: A review

Habib yaribeygi.

1 Neurosciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Yunes Panahi

2 Clinical Pharmacy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran

Hedayat Sahraei

Thomas p. johnston.

3 Division of Pharmaceutical Sciences, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, USA

Amirhossein Sahebkar

4 Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Any intrinsic or extrinsic stimulus that evokes a biological response is known as stress. The compensatory responses to these stresses are known as stress responses. Based on the type, timing and severity of the applied stimulus, stress can exert various actions on the body ranging from alterations in homeostasis to life-threatening effects and death. In many cases, the pathophysiological complications of disease arise from stress and the subjects exposed to stress, e.g. those that work or live in stressful environments, have a higher likelihood of many disorders. Stress can be either a triggering or aggravating factor for many diseases and pathological conditions. In this study, we have reviewed some of the major effects of stress on the primary physiological systems of humans.

Abbreviations

ACTH: Adrenocorticotropic hormone

CNS: Central nervous system

CRH: Corticotropin releasing hormone

GI: Gastrointestinal

LTP: Long-term potentiation

NMDA : N-methyl-D-aspartate

VTA: Ventral tegmental area

Stress and the Brain Function Complications

For a long time, researchers suggested that hormones have receptors just in the peripheral tissues and do not gain access to the central nervous system (CNS) (Lupien and Lepage, 2001[ 63 ]). However, observations have demonstrated the effect of anti-inflammatory drugs (which are considered synthetic hormones) on behavioral and cognitive disorders and the phenomenon called “Steroid psychosis” (Clark et al., 1952[ 16 ]). In the early sixties, neuropeptides were recognized as compounds devoid of effects on the peripheral endocrine system. However, it was determined that hormones are able to elicit biological effects on different parts of the CNS and play an important role in behavior and cognition (De Kloet, 2000[ 22 ]). In 1968, McEven suggested for the first time that the brain of rodents is capable of responding to glucocorticoid (as one of the operators in the stress cascade). This hypothesis that stress can cause functional changes in the CNS was then accepted (McEwen et al., 1968[ 74 ]). From that time on, two types of corticotropic receptors (glucocorticosteroids and mineralocorticoids) were recognized (de Kloet et al., 1999[ 23 ]). It was determined that the affinity of glucocorticosteroid receptors to cortisol and corticosterone was about one tenth of that of mineralocorticoids (de Kloet et al., 1999[ 23 ]). The hippocampus area has both types of receptors, while other points of the brain have only glucocorticosteroid receptors (de Kloet et al., 1999[ 23 ]).

The effects of stress on the nervous system have been investigated for 50 years (Thierry et al., 1968[ 115 ]). Some studies have shown that stress has many effects on the human nervous system and can cause structural changes in different parts of the brain (Lupien et al., 2009[ 65 ]). Chronic stress can lead to atrophy of the brain mass and decrease its weight (Sarahian et al., 2014[ 100 ]). These structural changes bring about differences in the response to stress, cognition and memory (Lupien et al., 2009[ 65 ]). Of course, the amount and intensity of the changes are different according to the stress level and the duration of stress (Lupien et al., 2009[ 65 ]). However, it is now obvious that stress can cause structural changes in the brain with long-term effects on the nervous system (Reznikov et al., 2007[ 89 ]). Thus, it is highly essential to investigate the effects of stress on different aspects of the nervous system (Table 1 (Tab. 1) ; References in Table 1: Lupien et al., 2001[ 63 ]; Woolley et al., 1990[ 122 ]; Sapolsky et al., 1990[ 99 ]; Gould et al., 1998[ 35 ]; Bremner, 1999[ 10 ]; Seeman et al., 1997[ 108 ]; Luine et al., 1994[ 62 ]; Li et al., 2008[ 60 ]; Scholey et al., 2014[ 101 ]; Borcel et al., 2008[ 9 ]; Lupien et al., 2002[ 66 ]).

Stress and Memory

Memory is one of the important functional aspects of the CNS and it is categorized as sensory, short term, and long-term. Short term memory is dependent on the function of the frontal and parietal lobes, while long-term memory depends on the function of large areas of the brain (Wood et al., 2000[ 121 ]). However, total function of memory and the conversion of short term memory to long-term memory are dependent on the hippocampus; an area of the brain that has the highest density of glucocorticosteroid receptors and also represents the highest level of response to stress (Scoville and Milner, 1957[ 107 ]; Asalgoo et al., 2015[ 1 ]). Therefore, during the past several decades, the relationship between the hippocampus and stress have been hotly debated (Asalgoo et al., 2015[ 1 ]; Lupien and Lepage, 2001[ 63 ]). In 1968, it was proven that there were cortisol receptors in the hippocampus of rats (McEwen et al., 1968[ 74 ]). Later, in 1982, by using specific agonists of glucocorticosteroid and mineralocorticoid receptors, the existence of these two receptors in the brain and hippocampus area of rats was proven (Veldhuis et al., 1982[ 119 ]). It should also be noted that the amygdala is very important to assessing the emotional experiences of memory (Roozendaal et al., 2009[ 91 ]).

The results of past studies have demonstrated the effect of stress on the process of memory (Ghodrat et al., 2014[ 32 ]). Various studies have shown that stress can cause functional and structural changes in the hippocampus section of the brain (McEwen, 1999[ 72 ]). These structural changes include atrophy and neurogenesis disorders (Lupien and Lepage, 2001[ 63 ]). Also, chronic stress and, consequently, an increase in plasma cortisol, leads to a reduction in the number of dendritic branches (Woolley et al., 1990[ 122 ]) and the number of neurons (Sapolsky et al., 1990[ 99 ]), as well as structural changes in synaptic terminals (Sapolsky et al., 1990[ 99 ]) and decreased neurogenesis in the hippocampus tissue (Gould et al., 1998[ 35 ]). Glucocorticosteroids can induce these changes by either effecting the cellular metabolism of neurons (Lawrence and Sapolsky, 1994[ 58 ]), or increasing the sensitivity of hippocampus cells to stimulatory amino acids (Sapolsky and Pulsinelli, 1985[ 98 ]) and/or increasing the level of extracellular glutamate (Sapolsky and Pulsinelli, 1985[ 98 ]).

High concentrations of stress hormones can cause declarative memory disorders (Lupien and Lepage, 2001[ 63 ]). Animal studies have shown that stress can cause a reversible reduction in spatial memory as a result of atrophy of the hippocampus (Luine et al., 1994[ 62 ]). In fact, high plasma concentrations of glucocorticosteroids for extended periods of time can cause atrophy of the hippocampus leading to memory disorders (Issa et al., 1990[ 45 ]). Additionally, people with either Cushing's syndrome (with an increased secretion of glucocorticosteroids), or people who receive high dosages of exogenous synthetic anti-inflammatory drugs, are observed to have atrophy of the hippocampus and associated memory disorders (Ling et al., 1981[ 61 ]). MRI images taken from the brains of people with post-traumatic stress disorder (PTSD) have demonstrated a reduction in the volume of the hippocampus along with neurophysiologic effects such as a weak verbal memory (Bremner, 1999[ 10 ]). Several human studies have suggested that even common therapeutic doses of glucocorticosteroids and dexamethasone can cause problems with explicit memory (Keenan et al., 1995[ 49 ]; Kirschbaum et al., 1996[ 53 ]). Thus, there is an inverse relationship between the level of cortisol and memory (Ling et al., 1981[ 61 ]), such that increasing levels of plasma cortisol following prolonged stress leads to a reduction in memory (Kirschbaum et al., 1996[ 53 ]), which improves when the level of plasma cortisol decreases (Seeman et al., 1997[ 108 ]).

Stress also has negative effects on learning. Results from hippocampus-dependent loading data demonstrate that subjects are not as familiar with a new environment after having been exposed to a new environment (Bremner, 1999[ 10 ]). Moreover, adrenal steroids lead to alteration in long-term potentiation (LTP), which is an important process in memory formation (Bliss and Lømo, 1973[ 7 ]).

Two factors are involved in the memory process during stress. The first is noradrenaline, which creates emotional aspects of memories in the basolateral amygdala area (Joëls et al., 2011[ 47 ]). Secondly, this process is facilitated by corticosteroids. However, if the release of corticosteroids occurs a few hours earlier, it causes inhibition of the amygdala and corresponding behaviors (Joëls et al., 2011[ 47 ]). Thus, there is a mutual balance between these two hormones for creating a response in the memory process (Joëls et al., 2011[ 47 ]).

Stress does not always affect memory. Sometimes, under special conditions, stress can actually improve memory (McEwen and Lupien, 2002[ 71 ]). These conditions include non-familiarity, non-predictability, and life-threatening aspects of imposed stimulation. Under these specific conditions, stress can temporarily improve the function of the brain and, therefore, memory. In fact, it has been suggested that stress can sharpen memory in some situations (Schwabe et al., 2010[ 105 ]). For example, it has been shown that having to take a written examination can improve memory for a short period of time in examination participants. Interestingly, this condition is associated with a decrease in the level of cortisol in the saliva (Vedhara et al., 2000[ 118 ]). Other studies have shown that impending stress before learning occurs can also lead to either an increase in the power of memory (Domes et al., 2002[ 27 ]; Schwabe et al., 2008[ 102 ]), or decrease in the capacity for memory (Diamond et al., 2006[ 26 ]; Kirschbaum et al., 1996[ 53 ]). This paradox results from the type of imposed stress and either the degree of emotional connection to the stressful event (Payne et al., 2007[ 83 ]; Diamond et al., 2007[ 25 ]), or the period of time between the imposing stress and the process of learning (Diamond et al., 2007[ 25 ]).

The process of strengthening memory is usually reinforced after stress (Schwabe et al., 2012[ 103 ]). Various studies on animal and human models have shown that administration of either glucocorticosteroids, or stress shortly after learning has occurred facilitates memory (Schwabe et al., 2012[ 103 ]). Also, it has been shown that glucocorticosteroids (not mineralocorticoids) are necessary to improve learning and memory (Lupien et al., 2002[ 66 ]). However, the retrieval of events in memory after exposure to stress will be decreased (Schwabe et al., 2012[ 103 ]), which may result from the competition of updated data for storage in memory in a stressful state (de Kloet et al., 1999[ 23 ]). Some investigations have shown that either exposure to stress, or injection of glucocorticosteroids before a test to assess retention, decreases the power of memory in humans and rodents (Schwabe and Wolf, 2009[ 104 ]).

In summary, it has been concluded that the effect of stress on memory is highly dependent on the time of exposure to the stressful stimulus and, in terms of the timing of the imposed stress, memory can be either better or worse (Schwabe et al., 2012[ 103 ]). Moreover, recent studies have shown that using a specific-timed schedule of exposure to stress not only affects hippocampus-dependent memory, but also striatum-dependent memory, which highlights the role of timing of the imposed stressful stimulus (Schwabe et al., 2010[ 105 ]).

Stress, Cognition and Learning

Cognition is another important feature of brain function. Cognition means reception and perception of perceived stimuli and its interpretation, which includes learning, decision making, attention, and judgment (Sandi, 2013[ 95 ]). Stress has many effects on cognition that depend on its intensity, duration, origin, and magnitude (Sandi, 2013[ 95 ]). Similar to memory, cognition is mainly formed in the hippocampus, amygdala, and temporal lobe (McEwen and Sapolsky, 1995[ 73 ]). The net effect of stress on cognition is a reduction in cognition and thus, it is said that any behavioral steps undertaken to reduce stress leads to increase in cognition (Scholey et al., 2014[ 101 ]). In fact, stress activates some physiological systems, such as the autonomic nervous system, central neurotransmitter and neuropeptide system, and the hypothalamus-pituitary-adrenal axis, which have direct effects on neural circuits in the brain involved with data processing (Sandi, 2013[ 95 ]). Activation of stress results in the production and release of glucocorticosteroids. Because of the lipophilic properties of glucocorticosteroids, they can diffuse through the blood-brain barrier and exert long-term effects on processing and cognition (Sandi, 2013[ 95 ]).

It appears that being exposed to stress can cause pathophysiologic changes in the brain, and these changes can be manifested as behavioral, cognitive, and mood disorders (Li et al., 2008[ 60 ]). In fact, studies have shown that chronic stress can cause complications such as increased IL-6 and plasma cortisol, but decreased amounts of cAMP responsive element binding protein and brain-derived neurotrophic factor (BDNF), which is very similar to what is observed in people with depression and mood disorders that exhibit a wide range of cognitive problems (Song et al., 2006[ 114 ]). Additionally, the increased concentrations of inflammatory factors, like interleukins and TNF-α (which play an important role in creating cognitive disorders), proves a physiologic relationship between stress and mood-based cognitive disorders (Solerte et al., 2000[ 113 ]; Marsland et al., 2006[ 68 ]; Li et al., 2008[ 60 ]). Studies on animals suggest that cognitive disorders resulting from stress are created due to neuroendocrine and neuroamine factors and neurodegenerative processes (Li et al., 2008[ 60 ]). However, it should be noted that depression may not always be due to the over activation of the physiological-based stress response (Osanloo et al., 2016[ 81 ]).

Cognitive disorders following exposure to stress have been reported in past studies (Lupien and McEwen, 1997[ 64 ]). Stress has effects on cognition both acutely (through catecholamines) and chronically (through glucocorticosteroids) (McEwen and Sapolsky, 1995[ 73 ]). Acute effects are mainly caused by beta-adrenergic effects, while chronic effects are induced in a long-term manner by changes in gene expression mediated by steroids (McEwen and Sapolsky, 1995[ 73 ]). In general, many mechanisms modulate the effects of stress on cognition (McEwen and Sapolsky, 1995[ 73 ]; Mendl, 1999[ 75 ]). For instance, adrenal steroids affect the function of the hippocampus during cognition and memory retrieval in a biphasic manner (McEwen and Sapolsky, 1995[ 73 ]). In chronic stress, these steroids can destroy neurons with other stimulatory neurotransmitters (Sandi, 2013[ 95 ]). Exposure to stress can also cause disorders in hippocampus-related cognition; specifically, spatial memory (Borcel et al., 2008[ 9 ]; Sandi et al., 2003[ 96 ]). Additionally, stress can halt or decrease the genesis of neurons in the dentate gyrus area of the hippocampus (this area is one of the limited brain areas in which neurogenesis occurs in adults) (Gould and Tanapat, 1999[ 34 ]; Köhler et al., 2010[ 54 ]). Although age is a factor known to affect cognition, studies on animals have demonstrated that young rats exposed to high doses of adrenal steroids show the same level of decline in their cognition as older adult animals with normal plasma concentrations of glucocorticoids (Landfield et al., 1978[ 57 ]). Also, a decrease in the secretion of glucocorticosteroids causes preservation of spatial memory in adults and has also been shown to have neuroprotective effects (Montaron et al., 2006[ 78 ]). Other studies have shown that stress (or the injection of adrenal steroids) results in varied effects on cognition. For instance, injection of hydrocortisone at the time of its maximum plasma concentration (in the afternoon) leads to a decrease in reaction time and improves cognition and memory (Lupien et al., 2002[ 66 ]).

In summary, the adverse effects of stress on cognition are diverse and depend on the type, timing, intensity, and duration (Sandi, 2013[ 95 ]). Generally, it is believed that mild stress facilitates an improvement in cognitive function, especially in the case of virtual or verbal memory. However, if the intensity of stress passes beyond a predetermined threshold (which is different in each individual), it causes cognitive disorders, especially in memory and judgment. The disruption to memory and judgment is due to the effects of stress on the hippocampus and prefrontal cortex (Sandi, 2013[ 95 ]). Of course, it must be realized that factors like age and gender may also play a role in some cognitive disorders (Sandi, 2013[ 95 ]). Importantly, it should be emphasized that different people may exhibit varied responses in cognition when exposed to the very same stressful stimulus (Hatef et al., 2015[ 39 ]).

Stress and Immune System Functions

The relationship between stress and the immune system has been considered for decades (Khansari et al., 1990[ 50 ]; Dantzer and Kelley, 1989[ 21 ]). The prevailing attitude between the association of stress and immune system response has been that people under stress are more likely to have an impaired immune system and, as a result, suffer from more frequent illness (Khansari et al., 1990[ 50 ]). Also, old anecdotes describing resistance of some people to severe disease using the power of the mind and their thought processes, has promoted this attitude (Khansari et al., 1990[ 50 ]). In about 200 AC, Aelius Galenus (Galen of Pergamon) declared that melancholic women (who have high levels of stress and, thus, impaired immune function) are more likely to have cancer than women who were more positive and exposed to less stress (Reiche et al., 2004[ 88 ]). This may be the first recorded case about the relationship between the immune system and stress. In an old study in the early 1920's, researchers found that the activity of phagocytes in tuberculosis decreased when emotional stress was induced. In fact, it was also suggested that living with stress increases the risk of tuberculosis by suppressing the immune system (Ishigami, 1919[ 44 ]). Following this study, other researchers suggested that the probability of disease appearance increases following a sudden, major, and extremely stressful life style change (Holmes and Rahe, 1967[ 41 ]; Calabrese et al., 1987[ 12 ]).

Over the past several decades, there have been many studies investigating the role of stress on immune system function (Dantzer and Kelley, 1989[ 21 ]; Segerstrom and Miller, 2004[ 109 ]). These studies have shown that stress mediators can pass through the blood-brain barrier and exert their effects on the immune system (Khansari et al., 1990[ 50 ]). Thus, the effect of stress on the immune system is now an accepted relationship or association.

Stress can affect the function of the immune system by modulating processes in the CNS and neuroendocrine system (Khansari et al., 1990[ 50 ]; Kiecolt-Glaser and Glaser, 1991[ 51 ]). Following stress, some neuroendocrine and neural responses result in the release of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and other stress mediators (Carrasco and Van de Kar, 2003[ 13 ]). However, evidence suggests that the lymphatic system, which is a part of the immune system, also plays a role in releasing these mediators (Khansari et al., 1990[ 50 ]). For instance, thymus peptides, such as thymopentine, thymopoietin, and thymosin fraction-5, cause an increase in ACTH production (Goya et al., 1993[ 36 ]). Additionally, the existence of CRH in thymus has been proven (Redei, 1992[ 87 ]). It has also been proven that interleukin-1 released from phagocytes has a role in ACTH secretion (Berkenbosch et al., 1987[ 4 ]). On the other hand, natural or synthetic glucocorticosteroids (which are the final stress operators) are known as anti-inflammatory drugs and immune suppressants and their role in the inhibition of lymphocytes and macrophages has been demonstrated as well (Elenkov et al., 1999[ 28 ]; Reiche et al., 2004[ 88 ]). Moreover, their role in inhibiting the production of cytokines and other immune mediators and decreasing their effect on target cells during exposure to stress has also been determined (Reiche et al., 2004[ 88 ]).

In addition to adrenal steroids, other hormones are affected during stress. For example, the secretion of growth hormone will be halted during severe stress. A study showed that long-term administration of CRH into the brain ventricles leads to a cessation in the release of growth hormone (Rivier and Vale, 1985[ 90 ]). Stress also causes the release of opioid peptides to be changed during the time period over which the person is exposed to stress (McCarthy et al., 2001[ 70 ]). In fact, stress modifies the secretion of hormones that play a critical role in the function of the immune system (Khansari et al., 1990[ 50 ]). To date, it has been shown that various receptors for a variety of hormones involved in immune system function are adversely affected by stress. For example, ACTH, vasoactive intestinal peptide (VIP), substance P, growth hormone, prolactin, and steroids all have receptors in various tissues of the immune system and can modulate its function (De la Fuente et al., 1996[ 24 ]; Gala, 1991[ 30 ]; Mantyh, 1991[ 67 ]). In addition, active immune cells are also able to secrete several hormones; thus, some researchers believe that these hormones, as mediators of immune system, play a significant role in balancing its function (Blalock et al., 1985[ 6 ]).

Severe stress can lead to malignancy by suppressing the immune system (Reiche et al., 2004[ 88 ]). In fact, stress can decrease the activity of cytotoxic T lymphocytes and natural killer cells and lead to growth of malignant cells, genetic instability, and tumor expansion (Reiche et al., 2004[ 88 ]). Studies have shown that the plasma concentration of norepinephrine, which increases after the induction stress, has an inverse relationship with the immune function of phagocytes and lymphocytes (Reiche et al., 2004[ 88 ]). Lastly, catecholamines and opioids that are released following stress have immune-suppressing properties (Reiche et al., 2004[ 88 ]).

Stress and the Function of the Cardiovascular System

The existence of a positive association between stress and cardiovascular disease has been verified (Rozanski et al., 1999[ 93 ]). Stress, whether acute or chronic, has a deleterious effect on the function of the cardiovascular system (Rozanski et al., 1999[ 93 ]; Kario et al., 2003[ 48 ]; Herd, 1991[ 40 ]). The effects of stress on the cardiovascular system are not only stimulatory, but also inhibitory in nature (Engler and Engler, 1995[ 29 ]). It can be postulated that stress causes autonomic nervous system activation and indirectly affects the function of the cardiovascular system (Lazarus et al., 1963[ 59 ]; Vrijkotte et al., 2000[ 120 ]). If these effects occur upon activation of the sympathetic nervous system, then it mainly results in an increase in heart rate, strength of contraction, vasodilation in the arteries of skeletal muscles, a narrowing of the veins, contraction of the arteries in the spleen and kidneys, and decreased sodium excretion by the kidneys (Herd, 1991[ 40 ]). Sometimes, stress activates the parasympathetic nervous system (Pagani et al., 1991[ 82 ]). Specifically, if it leads to stimulation of the limbic system, it results in a decrease, or even a total stopping of the heart-beat, decreased contractility, reduction in the guidance of impulses by the heart stimulus-transmission network, peripheral vasodilatation, and a decline in blood pressure (Cohen et al., 2000[ 17 ]). Finally, stress can modulate vascular endothelial cell function and increase the risk of thrombosis and ischemia, as well as increase platelet aggregation (Rozanski et al., 1999[ 93 ]).

The initial effect of stress on heart function is usually on the heart rate (Vrijkotte et al., 2000[ 120 ]). Depending upon the direction of the shift in the sympatho-vagal response, the heart beat will either increase or decrease (Hall et al., 2004[ 38 ]). The next significant effect of stress on cardiovascular function is blood pressure (Laitinen et al., 1999[ 56 ]). Stress can stimulate the autonomic sympathetic nervous system to increase vasoconstriction, which can mediate an increase in blood pressure, an increase in blood lipids, disorders in blood clotting, vascular changes, atherogenesis; all, of which, can cause cardiac arrhythmias and subsequent myocardial infarction (Rozanski et al., 1999[ 93 ]; Vrijkotte et al., 2000[ 120 ]; Sgoifo et al., 1998[ 111 ]). These effects from stress are observed clinically with atherosclerosis and leads to an increase in coronary vasoconstriction (Rozanski et al., 1999[ 93 ]). Of course, there are individual differences in terms of the level of autonomic-based responses due to stress, which depends on the personal characteristics of a given individual (Rozanski et al., 1999[ 93 ]). Thus, training programs for stress management are aimed at reducing the consequences of stress and death resulting from heart disease (Engler and Engler, 1995[ 29 ]). In addition, there are gender-dependent differences in the cardiovascular response to stress and, accordingly, it has been estimated that women begin to exhibit heart disease ten years later that men, which has been attributed to the protective effects of the estrogen hormone (Rozanski et al., 1999[ 93 ]).

Studies have shown that psychological stress can cause alpha-adrenergic stimulation and, consequently, increase heart rate and oxygen demand (Rozanski et al., 1998[ 92 ], 1999[ 93 ]; Jiang et al., 1996[ 46 ]). As a result, coronary vasoconstriction is enhanced, which may increase the risk of myocardial infarction (Yeung et al., 1991[ 124 ]; Boltwood et al., 1993[ 8 ]; Dakak et al., 1995[ 20 ]). Several studies have demonstrated that psychological stress decreases the microcirculation in the coronary arteries by an endothelium-dependent mechanism and increases the risk of myocardial infarction (Dakak et al., 1995[ 20 ]). On the other hand, mental stress indirectly leads to potential engagement in risky behaviors for the heart, such as smoking, and directly leads to stimulation of the neuroendocrine system as part of the autonomic nervous system (Hornstein, 2004[ 43 ]). It has been suggested that severe mental stress can result in sudden death (Pignalberi et al., 2002[ 84 ]). Generally, stress-mediated risky behaviors that impact cardiovascular health can be summarized into five categories: an increase in the stimulation of the sympathetic nervous system, initiation and progression of myocardial ischemia, development of cardiac arrhythmias, stimulation of platelet aggregation, and endothelial dysfunction (Wu, 2001[ 123 ]).

Stress and Gastrointestinal Complications

The effects of stress on nutrition and the gastrointestinal (GI) system can be summarized with two aspects of GI function.

First, stress can affect appetite (Bagheri Nikoo et al., 2014[ 2 ]; Halataei et al., 2011[ 37 ]; Ranjbaran et al., 2013[ 86 ]). This effect is related to involvement of either the ventral tegmental area (VTA), or the amygdala via N-methyl-D-aspartate (NMDA) glutamate receptors (Nasihatkon et al., 2014[ 80 ]; Sadeghi et al., 2015[ 94 ]). However, it should also be noted that nutrition patterns have effects on the response to stress (Ghanbari et al., 2015[ 31 ]), and this suggests a bilateral interaction between nutrition and stress.

Second, stress adversely affects the normal function of GI tract. There are many studies concerning the effect of stress on the function of the GI system (Söderholm and Perdue, 2001[ 112 ]; Collins, 2001[ 18 ]). For instance, studies have shown that stress affects the absorption process, intestinal permeability, mucus and stomach acid secretion, function of ion channels, and GI inflammation (Collins, 2001[ 18 ]; Nabavizadeh et al., 2011[ 79 ]). Stress also increases the response of the GI system to inflammation and may reactivate previous inflammation and accelerate the inflammation process by secretion of mediators such as substance P (Collins, 2001[ 18 ]). As a result, there is an increase in the permeability of cells and recruitment of T lymphocytes. Lymphocyte aggregation leads to the production of inflammatory markers, activates key pathways in the hypothalamus, and results in negative feedback due to CRH secretion, which ultimately results in the appearance of GI inflammatory diseases (Collins, 2001[ 18 ]). This process can reactivate previous silent colitis (Million et al., 1999[ 76 ]; Qiu et al., 1999[ 85 ]). Mast cells play a crucial role in stress-induced effects on the GI system, because they cause neurotransmitters and other chemical factors to be released that affect the function of the GI system (Konturek et al., 2011[ 55 ]).

Stress can also alter the functional physiology of the intestine (Kiliaan et al., 1998[ 52 ]). Many inflammatory diseases, such as Crohn's disease and other ulcerative-based diseases of the GI tract, are associated with stress (Hommes et al., 2002[ 42 ]). It has been suggested that even childhood stress can lead to these diseases in adulthood (Schwartz and Schwartz, 1983[ 106 ]). Irritable bowel syndrome, which is a disease with an inflammatory origin, is highly related to stress (Gonsalkorale et al., 2003[ 33 ]). Studies on various animals suggest the existence of inflammatory GI diseases following induction of severe stress (Qiu et al., 1999[ 85 ]; Collins et al., 1996[ 19 ]). Additionally, pharmacological interventions, in an attempt to decrease the response of CRH to stress, have been shown to result in an increase in GI diseases in rats (Million et al., 1999[ 76 ]).

Altering the permeability of the mucosal membrane by perturbing the functions of mucosal mast cells may be another way that stress causes its effects on the GI system, since this is a normal process by which harmful and toxic substances are removed from the intestinal lumen (Söderholm and Perdue, 2001[ 112 ]). Also, stress can both decrease the removal of water from the lumen, as well as induce sodium and chloride secretion into the lumen. This most likely occurs by increasing the activity of the parasympathetic nervous system (Barclay and Turnberg, 1987[ 3 ]). Moreover, physical stress, such as trauma or surgery, can increase luminal permeability (Söderholm and Perdue, 2001[ 112 ]) (Table 2 (Tab. 2) ; References in Table 2: Halataei et al., 2011[ 37 ]; Ranjbaran et al., 2013[ 86 ]; Mönnikes et al., 2001[ 77 ]; Collins, 2001[ 18 ]; Nabavizadeh et al., 2011[ 79 ]; Barclay and Turnberg, 1987[ 3 ]; Million et al., 1999[ 76 ]; Gonsalkorale et al., 2003[ 33 ]).

Stress also affects movement of the GI tract. In this way, it prevents stomach emptying and accelerates colonic motility (Mönnikes et al., 2001[ 77 ]). In the case of irritable bowel syndrome, stress increases the movement (contractility and motility) of the large intestine (Mönnikes et al., 2001[ 77 ]). Previous studies have revealed that CRH increases movement in the terminal sections of the GI tract and decreases the movements in the proximal sections of the GI tract (Mönnikes et al., 2001[ 77 ]). A delay in stomach emptying is likely accomplished through CRH-2 receptors, while type 1 receptors affect the colon (Mönnikes et al., 2001[ 77 ]). The effects produced by CRH are so prominent that CRH is now considered an ideal candidate for the treatment of irritable bowel syndrome (Martinez and Taché, 2006[ 69 ]). When serotonin is released in response to stress (Chaouloff, 2000[ 14 ]), it leads to an increase in the motility of the colon by stimulating 5HT-3 receptors (Mönnikes et al., 2001[ 77 ]). Moreover, it has also been suggested that stress, especially mental and emotional types of stress, increase visceral sensitivity and activate mucosal mast cells (Mönnikes et al., 2001[ 77 ]). Stimulation of the CNS by stress has a direct effect on GI-specific nervous system ( i.e. , the myenteric system or plexus) and causes the above mentioned changes in the movements of the GI tract (Bhatia and Tandon, 2005[ 5 ]). In fact, stress has a direct effect on the brain-bowel axis (Konturek et al., 2011[ 55 ]). Various clinical studies have suggested a direct effect of stress on irritable bowel syndrome, intestinal inflammation, and peptic ulcers (Konturek et al., 2011[ 55 ]).

In conclusion, the effects of stress on the GI system can be classified into six different actions: GI tract movement disorders, increased visceral irritability, altered rate and extent of various GI secretions, modified permeability of the intestinal barrier, negative effects on blood flow to the GI tract, and increased intestinal bacteria counts (Konturek et al., 2011[ 55 ]).

Stress and the Endocrine System

There is a broad and mutual relationship between stress and the endocrine system. On one hand, stress has many subtle and complex effects on the activity of the endocrine system (Sapolsky, 2002[ 97 ]; Charmandari et al., 2005[ 15 ]), while on the other hand, the endocrine system has many effects on the response to stress (Ulrich-Lai and Herman, 2009[ 117 ]; Selye, 1956[ 110 ]). Stress can either activate, or change the activity of, many endocrine processes associated with the hypothalamus, pituitary and adrenal glands, the adrenergic system, gonads, thyroid, and the pancreas (Tilbrook et al., 2000[ 116 ]; Brown-Grant et al., 1954[ 11 ]; Thierry et al., 1968[ 115 ]; Lupien and McEwen, 1997[ 64 ]). In fact, it has been suggested that it is impossible to separate the response to stress from the functions of the endocrine system. This premise has been advanced due to the fact that even a minimal amount of stress can activate the hypothalamic-pituitary-adrenal axis, which itself is intricately involved with the activation of several different hormone secreting systems (Sapolsky, 2002[ 97 ]). In different locations throughout this article, we have already discussed the effects of stress on hormones and various endocrine factors and, thus, they will not be further addressed.

Altogether, stress may induce both beneficial and harmful effects. The beneficial effects of stress involve preserving homeostasis of cells/species, which leads to continued survival. However, in many cases, the harmful effects of stress may receive more attention or recognition by an individual due to their role in various pathological conditions and diseases. As has been discussed in this review, various factors, for example, hormones, neuroendocrine mediators, peptides, and neurotransmitters are involved in the body's response to stress. Many disorders originate from stress, especially if the stress is severe and prolonged. The medical community needs to have a greater appreciation for the significant role that stress may play in various diseases and then treat the patient accordingly using both pharmacological (medications and/or nutraceuticals) and non-pharmacological (change in lifestyle, daily exercise, healthy nutrition, and stress reduction programs) therapeutic interventions. Important for the physician providing treatment for stress is the fact that all individuals vary in their response to stress, so a particular treatment strategy or intervention appropriate for one patient may not be suitable or optimal for a different patient.

Yunes Panahi and Amirhossein Sahebkar (Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, P.O. Box: 91779-48564, Iran; Tel: 985118002288, Fax: 985118002287, E-mail: [email protected], [email protected]) contributed equally as corresponding authors.

Conflict of interest

The authors declare that have no conflict of interest in this study.

Acknowledgement

The authors would like to thank the "Neurosciences Research Center of Baqiyatallah University of Medical Sciences" and the “Clinical Research Development Center of Baqiyatallah (a.s.) Hospital” for providing technical supports.

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What Is Stress?

Your Body's Response to a Situation That Requires Attention or Action

Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

• Identifying
• Next in How Stress Impacts Your Health Guide How to Recognize Burnout Symptoms

Stress can be defined as any type of change that causes physical , emotional, or psychological strain. Stress is your body's response to anything that requires attention or action. 

Everyone experiences stress to some degree. The way you respond to stress, however, makes a big difference to your overall well-being.

Verywell / Brianna Gilmartin

Sometimes, the best way to manage your stress involves changing your situation. At other times, the best strategy involves changing the way you respond to the situation.

Developing a clear understanding of how stress impacts your physical and mental health is important. It's also important to recognize how your mental and physical health affects your stress level.

Watch Now: 5 Ways Stress Can Cause Weight Gain

Signs of stress.

Stress can be short-term or long-term. Both can lead to a variety of symptoms, but chronic stress can take a serious toll on the body over time and have long-lasting health effects.

Some common signs of stress include:

• Changes in mood
• Clammy or sweaty palms
• Decreased sex drive
• Difficulty sleeping
• Digestive problems
• Feeling anxious
• Frequent sickness
• Grinding teeth
• Muscle tension, especially in the neck and shoulders
• Physical aches and pains
• Racing heartbeat

Identifying Stress

What does stress feel like? What does stress feel like? It often contributes to irritability, fear, overwork, and frustration. You may feel physically exhausted, worn out, and unable to cope.

Stress is not always easy to recognize, but there are some ways to identify some signs that you might be experiencing too much pressure. Sometimes stress can come from an obvious source, but sometimes even small daily stresses from work, school, family, and friends can take a toll on your mind and body.

If you think stress might be affecting you, there are a few things you can watch for:

• Psychological signs such as difficulty concentrating, worrying, anxiety, and trouble remembering
• Emotional signs such as being angry, irritated, moody, or frustrated
• Physical signs such as high blood pressure, changes in weight, frequent colds or infections, and changes in the menstrual cycle and libido
• Behavioral signs such as poor self-care, not having time for the things you enjoy, or relying on drugs and alcohol to cope

Stress vs. Anxiety

Stress can sometimes be mistaken for anxiety, and experiencing a great deal of stress can contribute to feelings of anxiety. Experiencing anxiety can make it more difficult to cope with stress and may contribute to other health issues, including increased depression, susceptibility to illness, and digestive problems.

Stress and anxiety contribute to nervousness, poor sleep, high blood pressure , muscle tension, and excess worry. In most cases, stress is caused by external events, while anxiety is caused by your internal reaction to stress. Stress may go away once the threat or the situation resolves, whereas anxiety may persist even after the original stressor is gone.

Causes of Stress

There are many different things in life that can cause stress. Some of the main sources of stress include work, finances, relationships, parenting, and day-to-day inconveniences.

Stress can trigger the body’s response to a perceived threat or danger, known as the fight-or-flight response .   During this reaction, certain hormones like adrenaline and cortisol are released. This speeds the heart rate, slows digestion, shunts blood flow to major muscle groups, and changes various other autonomic nervous functions, giving the body a burst of energy and strength.

Originally named for its ability to enable us to physically fight or run away when faced with danger, the fight-or-flight response is now activated in situations where neither response is appropriate—like in traffic or during a stressful day at work.

When the perceived threat is gone, systems are designed to return to normal function via the relaxation response .   But in cases of chronic stress, the relaxation response doesn't occur often enough, and being in a near-constant state of fight-or-flight can cause damage to the body.

Stress can also lead to some unhealthy habits that have a negative impact on your health. For example, many people cope with stress by eating too much or by smoking. These unhealthy habits damage the body and create bigger problems in the long-term.  

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Types of Stress

Not all types of stress are harmful or even negative. Some of the different types of stress that you might experience include:

• Acute stress : Acute stress is a very short-term type of stress that can either be positive or more distressing; this is the type of stress we most often encounter in day-to-day life.
• Chronic stress : Chronic stress is stress that seems never-ending and inescapable, like the stress of a bad marriage or an extremely taxing job; chronic stress can also stem from traumatic experiences and childhood trauma.
• Episodic acute stress : Episodic acute stress is acute stress that seems to run rampant and be a way of life, creating a life of ongoing distress.
• Eustress : Eustress is fun and exciting. It's known as a positive type of stress that can keep you energized. It's associated with surges of adrenaline, such as when you are skiing or racing to meet a deadline. 

4 Main Types of Stress:

The main harmful types of stress are acute stress, chronic stress, and episodic acute stress. Acute stress is usually brief, chronic stress is prolonged, and episodic acute stress is short-term but frequent. Positive stress, known as eustress, can be fun and exciting, but it can also take a toll.

Impact of Stress

Stress can have several effects on your health and well-being. It can make it more challenging to deal with life's daily hassles, affect your interpersonal relationships, and have detrimental effects on your health. The connection between your mind and body is apparent when you examine stress's impact on your life.

Feeling stressed over a relationship, money, or living situation can create physical health issues. The inverse is also true. Health problems, whether you're dealing with high blood pressure or diabetes , will also affect your stress level and mental health. When your brain experiences high degrees of stress , your body reacts accordingly.

Serious acute stress, like being involved in a natural disaster or getting into a verbal altercation, can trigger heart attacks, arrhythmias, and even sudden death. However, this happens mostly in individuals who already have heart disease.

Stress also takes an emotional toll. While some stress may produce feelings of mild anxiety or frustration, prolonged stress can also lead to burnout , anxiety disorders , and depression.

Chronic stress can have a serious impact on your health as well. If you experience chronic stress, your autonomic nervous system will be overactive, which is likely to damage your body.

Stress-Influenced Conditions

• Heart disease
• Hyperthyroidism
• Sexual dysfunction
• Tooth and gum disease

Treatments for Stress

Stress is not a distinct medical diagnosis and there is no single, specific treatment for it. Treatment for stress focuses on changing the situation, developing stress coping skills , implementing relaxation techniques, and treating symptoms or conditions that may have been caused by chronic stress.

Some interventions that may be helpful include therapy, medication, and complementary and alternative medicine (CAM).

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Psychotherapy

Some forms of therapy that may be particularly helpful in addressing symptoms of stress including cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) . CBT focuses on helping people identify and change negative thinking patterns, while MBSR utilizes meditation and mindfulness to help reduce stress levels.

Medication may sometimes be prescribed to address some specific symptoms that are related to stress. Such medications may include sleep aids, antacids, antidepressants, and anti-anxiety medications.

Complementary and Alternative Medicine

Some complementary approaches that may also be helpful for reducing stress include acupuncture, aromatherapy, massage, yoga, and meditation .

Coping With Stress

Although stress is inevitable, it can be manageable. When you understand the toll it takes on you and the steps to combat stress, you can take charge of your health and reduce the impact stress has on your life.

• Learn to recognize the signs of burnout. High levels of stress may place you at a high risk of burnout. Burnout can leave you feeling exhausted and apathetic about your job.   When you start to feel symptoms of emotional exhaustion, it's a sign that you need to find a way to get a handle on your stress.
• Try to get regular exercise. Physical activity has a big impact on your brain and your body . Whether you enjoy Tai Chi or you want to begin jogging, exercise reduces stress and improves many symptoms associated with mental illness.  
• Take care of yourself. Incorporating regular self-care activities into your daily life is essential to stress management. Learn how to take care of your mind, body, and spirit and discover how to equip yourself to live your best life.  
• Practice mindfulness in your life. Mindfulness isn't just something you practice for 10 minutes each day. It can also be a way of life. Discover how to live more mindfully throughout your day so you can become more awake and conscious throughout your life.  

If you or a loved one are struggling with stress, contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our  National Helpline Database .

Cleveland Clinic. Stress .

National institute of Mental Health. I'm so stressed out! Fact sheet .

Goldstein DS. Adrenal responses to stress .  Cell Mol Neurobiol . 2010;30(8):1433–1440. doi:10.1007/s10571-010-9606-9

Stahl JE, Dossett ML, LaJoie AS, et al. Relaxation response and resiliency training and its effect on healthcare resource utilization [published correction appears in PLoS One . 2017 Feb 21;12 (2):e0172874].  PLoS One . 2015;10(10):e0140212. doi:10.1371/journal.pone.0140212

American Heart Association. Stress and Heart Health.

Chi JS, Kloner RA. Stress and myocardial infarction .  Heart . 2003;89(5):475–476. doi:10.1136/heart.89.5.475

Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies .  PLoS One . 2017;12(10):e0185781. Published 2017 Oct 4. doi:10.1371/journal.pone.0185781

Bitonte RA, DeSanto DJ 2nd. Mandatory physical exercise for the prevention of mental illness in medical students .  Ment Illn . 2014;6(2):5549. doi:10.4081/mi.2014.5549

Ayala EE, Winseman JS, Johnsen RD, Mason HRC. U.S. medical students who engage in self-care report less stress and higher quality of life .  BMC Med Educ . 2018;18(1):189. doi:10.1186/s12909-018-1296-x

Richards KC, Campenni CE, Muse-Burke JL. Self-care and well-being in mental health professionals: The mediating effects of self-awareness and mindfulness .  J Ment Health Couns . 2010;32(3):247. doi:10.17744/mehc.32.3.0n31v88304423806.

American Psychological Association. 2015 Stress in America .

Krantz DS, Whittaker KS, Sheps DS.  Psychosocial risk factors for coronary heart disease: Pathophysiologic mechanisms .  In R. Allan & J. Fisher,  Heart and mind: The practice of cardiac psychology. American Psychological Association; 2011:91-113. doi:10.1037/13086-004

By Elizabeth Scott, PhD Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

• A-Z Publications

Annual Review of Psychology

Volume 72, 2021, review article, stress and health: a review of psychobiological processes.

• Daryl B. O'Connor 1 , Julian F. Thayer 2 , and Kavita Vedhara 3
• View Affiliations Hide Affiliations Affiliations: 1 School of Psychology, University of Leeds, Leeds LS2 9JT, United Kingdom; email: [email protected] 2 Department of Psychological Science, School of Social Ecology, University of California, Irvine, California 92697, USA; email: [email protected] 3 Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom; email: [email protected]
• Vol. 72:663-688 (Volume publication date January 2021) https://doi.org/10.1146/annurev-psych-062520-122331
• First published as a Review in Advance on September 04, 2020
• Copyright © 2021 by Annual Reviews. All rights reserved

The cumulative science linking stress to negative health outcomes is vast. Stress can affect health directly, through autonomic and neuroendocrine responses, but also indirectly, through changes in health behaviors. In this review, we present a brief overview of ( a ) why we should be interested in stress in the context of health; ( b ) the stress response and allostatic load; ( c ) some of the key biological mechanisms through which stress impacts health, such as by influencing hypothalamic-pituitary-adrenal axis regulation and cortisol dynamics, the autonomic nervous system, and gene expression; and ( d ) evidence of the clinical relevance of stress, exemplified through the risk of infectious diseases. The studies reviewed in this article confirm that stress has an impact on multiple biological systems. Future work ought to consider further the importance of early-life adversity and continue to explore how different biological systems interact in the context of stress and health processes.

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Stress effects on the body

Stress affects all systems of the body including the musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems.

Our bodies are well equipped to handle stress in small doses, but when that stress becomes long-term or chronic, it can have serious effects on your body.

Musculoskeletal system

When the body is stressed, muscles tense up. Muscle tension is almost a reflex reaction to stress—the body’s way of guarding against injury and pain.

With sudden onset stress, the muscles tense up all at once, and then release their tension when the stress passes. Chronic stress causes the muscles in the body to be in a more or less constant state of guardedness. When muscles are taut and tense for long periods of time, this may trigger other reactions of the body and even promote stress-related disorders.

For example, both tension-type headache and migraine headache are associated with chronic muscle tension in the area of the shoulders, neck and head. Musculoskeletal pain in the low back and upper extremities has also been linked to stress, especially job stress.

Millions of individuals suffer from chronic painful conditions secondary to musculoskeletal disorders. Often, but not always, there may be an injury that sets off the chronic painful state. What determines whether or not an injured person goes on to suffer from chronic pain is how they respond to the injury. Individuals who are fearful of pain and re-injury, and who seek only a physical cause and cure for the injury, generally have a worse recovery than individuals who maintain a certain level of moderate, physician-supervised activity. Muscle tension, and eventually, muscle atrophy due to disuse of the body, all promote chronic, stress-related musculoskeletal conditions.

Relaxation techniques and other stress-relieving activities and therapies have been shown to effectively reduce muscle tension, decrease the incidence of certain stress-related disorders, such as headache, and increase a sense of well-being. For those who develop chronic pain conditions, stress-relieving activities have been shown to improve mood and daily function.

Respiratory system

The respiratory system supplies oxygen to cells and removes carbon dioxide waste from the body. Air comes in through the nose and goes through the larynx in the throat, down through the trachea, and into the lungs through the bronchi. The bronchioles then transfer oxygen to red blood cells for circulation.

Stress and strong emotions can present with respiratory symptoms, such as shortness of breath and rapid breathing, as the airway between the nose and the lungs constricts. For people without respiratory disease, this is generally not a problem as the body can manage the additional work to breathe comfortably, but psychological stressors can exacerbate breathing problems for people with pre-existing respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD; includes emphysema and chronic bronchitis).

Some studies show that an acute stress—such as the death of a loved one—can actually trigger asthma attacks. In addition, the rapid breathing—or hyperventilation—caused by stress can bring on a panic attack in someone prone to panic attacks.

Working with a psychologist to develop relaxation, breathing, and other cognitive behavioral strategies can help.

Cardiovascular system

The heart and blood vessels comprise the two elements of the cardiovascular system that work together in providing nourishment and oxygen to the organs of the body. The activity of these two elements is also coordinated in the body’s response to stress. Acute stress—stress that is momentary or short-term such as meeting deadlines, being stuck in traffic or suddenly slamming on the brakes to avoid an accident—causes an increase in heart rate and stronger contractions of the heart muscle, with the stress hormones—adrenaline, noradrenaline, and cortisol—acting as messengers for these effects.

In addition, the blood vessels that direct blood to the large muscles and the heart dilate, thereby increasing the amount of blood pumped to these parts of the body and elevating blood pressure. This is also known as the fight or flight response. Once the acute stress episode has passed, the body returns to its normal state.

Chronic stress, or a constant stress experienced over a prolonged period of time, can contribute to long-term problems for heart and blood vessels. The consistent and ongoing increase in heart rate, and the elevated levels of stress hormones and of blood pressure, can take a toll on the body. This long-term ongoing stress can increase the risk for hypertension, heart attack, or stroke.

Repeated acute stress and persistent chronic stress may also contribute to inflammation in the circulatory system, particularly in the coronary arteries, and this is one pathway that is thought to tie stress to heart attack. It also appears that how a person responds to stress can affect cholesterol levels.

The risk for heart disease associated with stress appears to differ for women, depending on whether the woman is premenopausal or postmenopausal. Levels of estrogen in premenopausal women appears to help blood vessels respond better during stress, thereby helping their bodies to better handle stress and protecting them against heart disease. Postmenopausal women lose this level of protection due to loss of estrogen, therefore putting them at greater risk for the effects of stress on heart disease.

Endocrine system

When someone perceives a situation to be challenging, threatening, or uncontrollable, the brain initiates a cascade of events involving the hypothalamic-pituitary-adrenal (HPA) axis, which is the primary driver of the endocrine stress response. This ultimately results in an increase in the production of steroid hormones called glucocorticoids, which include cortisol, often referred to as the “stress hormone”.

The HPA axis During times of stress, the hypothalamus, a collection of nuclei that connects the brain and the endocrine system, signals the pituitary gland to produce a hormone, which in turn signals the adrenal glands, located above the kidneys, to increase the production of cortisol.

Cortisol increases the level of energy fuel available by mobilizing glucose and fatty acids from the liver. Cortisol is normally produced in varying levels throughout the day, typically increasing in concentration upon awakening and slowly declining throughout the day, providing a daily cycle of energy.

During a stressful event, an increase in cortisol can provide the energy required to deal with prolonged or extreme challenge.

Stress and health Glucocorticoids, including cortisol, are important for regulating the immune system and reducing inflammation. While this is valuable during stressful or threatening situations where injury might result in increased immune system activation, chronic stress can result in impaired communication between the immune system and the HPA axis.

This impaired communication has been linked to the future development of numerous physical and mental health conditions, including chronic fatigue, metabolic disorders (e.g., diabetes, obesity), depression, and immune disorders.

Gastrointestinal system

The gut has hundreds of millions of neurons which can function fairly independently and are in constant communication with the brain—explaining the ability to feel “butterflies” in the stomach. Stress can affect this brain-gut communication, and may trigger pain, bloating, and other gut discomfort to be felt more easily. The gut is also inhabited by millions of bacteria which can influence its health and the brain’s health, which can impact the ability to think and affect emotions.

Stress is associated with changes in gut bacteria which in turn can influence mood. Thus, the gut’s nerves and bacteria strongly influence the brain and vice versa.

Early life stress can change the development of the nervous system as well as how the body reacts to stress. These changes can increase the risk for later gut diseases or dysfunctioning.

Esophagus When stressed, individuals may eat much more or much less than usual. More or different foods, or an increase in the use of alcohol or tobacco, can result in heartburn or acid reflux. Stress or exhaustion can also increase the severity of regularly occurring heartburn pain. A rare case of spasms in the esophagus can be set off by intense stress and can be easily mistaken for a heart attack.

Stress also may make swallowing foods difficult or increase the amount of air that is swallowed, which increases burping, gassiness, and bloating.

Stomach Stress may make pain, bloating, nausea, and other stomach discomfort felt more easily. Vomiting may occur if the stress is severe enough. Furthermore, stress may cause an unnecessary increase or decrease in appetite. Unhealthy diets may in turn deteriorate one’s mood.

Contrary to popular belief, stress does not increase acid production in the stomach, nor causes stomach ulcers. The latter are actually caused by a bacterial infection. When stressed, ulcers may be more bothersome.

Bowel Stress can also make pain, bloating, or discomfort felt more easily in the bowels. It can affect how quickly food moves through the body, which can cause either diarrhea or constipation. Furthermore, stress can induce muscle spasms in the bowel, which can be painful.

Stress can affect digestion and what nutrients the intestines absorb. Gas production related to nutrient absorption may increase.

The intestines have a tight barrier to protect the body from (most) food related bacteria. Stress can make the intestinal barrier weaker and allow gut bacteria to enter the body. Although most of these bacteria are easily taken care of by the immune system and do not make us sick, the constant low need for inflammatory action can lead to chronic mild symptoms.

Stress especially affects people with chronic bowel disorders, such as inflammatory bowel disease or irritable bowel syndrome. This may be due to the gut nerves being more sensitive, changes in gut microbiota, changes in how quickly food moves through the gut, and/or changes in gut immune responses.

Nervous system

The nervous system has several divisions: the central division involving the brain and spinal cord and the peripheral division consisting of the autonomic and somatic nervous systems.

The autonomic nervous system has a direct role in physical response to stress and is divided into the sympathetic nervous system (SNS), and the parasympathetic nervous system (PNS). When the body is stressed, the SNS contributes to what is known as the “fight or flight” response. The body shifts its energy resources toward fighting off a life threat, or fleeing from an enemy.

The SNS signals the adrenal glands to release hormones called adrenalin (epinephrine) and cortisol. These hormones, together with direct actions of autonomic nerves, cause the heart to beat faster, respiration rate to increase, blood vessels in the arms and legs to dilate, digestive process to change and glucose levels (sugar energy) in the bloodstream to increase to deal with the emergency.

The SNS response is fairly sudden in order to prepare the body to respond to an emergency situation or acute stress—short term stressors. Once the crisis is over, the body usually returns to the pre-emergency, unstressed state. This recovery is facilitated by the PNS, which generally has opposing effects to the SNS. But PNS over-activity can also contribute to stress reactions, for example, by promoting bronchoconstriction (e.g., in asthma) or exaggerated vasodilation and compromised blood circulation.

Both the SNS and the PNS have powerful interactions with the immune system, which can also modulate stress reactions. The central nervous system is particularly important in triggering stress responses, as it regulates the autonomic nervous system and plays a central role in interpreting contexts as potentially threatening.

Chronic stress, experiencing stressors over a prolonged period of time, can result in a long-term drain on the body. As the autonomic nervous system continues to trigger physical reactions, it causes a wear-and-tear on the body. It’s not so much what chronic stress does to the nervous system, but what continuous activation of the nervous system does to other bodily systems that become problematic.

Male reproductive system

The male reproductive system is influenced by the nervous system. The parasympathetic part of the nervous system causes relaxation whereas the sympathetic part causes arousal. In the male anatomy, the autonomic nervous system, also known as the fight or flight response, produces testosterone and activates the sympathetic nervous system which creates arousal.

Stress causes the body to release the hormone cortisol, which is produced by the adrenal glands. Cortisol is important to blood pressure regulation and the normal functioning of several body systems including cardiovascular, circulatory, and male reproduction. Excess amounts of cortisol can affect the normal biochemical functioning of the male reproductive system.

Sexual desire Chronic stress, ongoing stress over an extended period of time, can affect testosterone production resulting in a decline in sex drive or libido, and can even cause erectile dysfunction or impotence.

Reproduction Chronic stress can also negatively impact sperm production and maturation, causing difficulties in couples who are trying to conceive. Researchers have found that men who experienced two or more stressful life events in the past year had a lower percentage of sperm motility (ability to swim) and a lower percentage of sperm of normal morphology (size and shape), compared with men who did not experience any stressful life events.

Diseases of the reproductive system When stress affects the immune system, the body can become vulnerable to infection. In the male anatomy, infections to the testes, prostate gland, and urethra, can affect normal male reproductive functioning.

Female reproductive system

Menstruation Stress may affect menstruation among adolescent girls and women in several ways. For example, high levels of stress may be associated with absent or irregular menstrual cycles, more painful periods, and changes in the length of cycles.

Sexual desire Women juggle personal, family, professional, financial, and a broad range of other demands across their life span. Stress, distraction, fatigue, etc., may reduce sexual desire—especially when women are simultaneously caring for young children or other ill family members, coping with chronic medical problems, feeling depressed, experiencing relationship difficulties or abuse, dealing with work problems, etc.

Pregnancy Stress can have significant impact on a woman’s reproductive plans. Stress can negatively impact a woman’s ability to conceive, the health of her pregnancy, and her postpartum adjustment. Depression is the leading complication of pregnancy and postpartum adjustment.

Excess stress increases the likelihood of developing depression and anxiety during this time. Maternal stress can negatively impact fetal and ongoing childhood development and disrupt bonding with the baby in the weeks and months following delivery.

Premenstrual syndrome Stress may make premenstrual symptoms worse or more difficult to cope with and premenses symptoms may be stressful for many women. These symptoms include cramping, fluid retention and bloating, negative mood (feeling irritable and “blue”) and mood swings.

Menopause As menopause approaches, hormone levels fluctuate rapidly. These changes are associated with anxiety, mood swings, and feelings of distress. Thus menopause can be a stressor in and of itself. Some of the physical changes associated with menopause, especially hot flashes, can be difficult to cope with.

Furthermore, emotional distress may cause the physical symptoms to be worse. For example, women who are more anxious may experience an increased number of hot flashes and/or more severe or intense hot flashes.

Diseases of the reproductive system When stress is high, there is increased chance of exacerbation of symptoms of reproductive disease states, such as herpes simplex virus or polycystic ovarian syndrome. The diagnosis and treatment of reproductive cancers can cause significant stress, which warrants additional attention and support.

Stress management

These recent discoveries about the effects of stress on health shouldn’t leave you worrying. We now understand much more about effective strategies for reducing stress responses. Such beneficial strategies include:

• Maintaining a healthy social support network
• Engaging in regular physical exercise
• Getting an adequate amount of sleep each night

These approaches have important benefits for physical and mental health, and form critical building blocks for a healthy lifestyle. If you would like additional support or if you are experiencing extreme or chronic stress, a licensed psychologist can help you identify the challenges and stressors that affect your daily life and find ways to help you best cope for improving your overall physical and mental well-being.

APA gratefully acknowledges the assistance of William Shaw, PhD; Susan Labott-Smith, PhD, ABPP; Matthew M. Burg, PhD; Camelia Hostinar, PhD; Nicholas Alen, BA; Miranda A.L. van Tilburg, PhD; Gary G. Berntson, PhD; Steven M. Tovian, PhD, ABPP, FAClinP, FAClinHP; and Malina Spirito, PsyD, MEd; in developing this article.

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Chronic stress can wreak havoc on your mind and body. Take steps to control your stress.

Your body is made to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today. But that doesn't mean that life is free of stress.

Instead, you likely face many demands each day. For example, you may take on a huge workload, pay bills or take care of your family. Your body treats these everyday tasks as threats. Because of this, you may feel as if you're always under attack. But you can fight back. You don't have to let stress control your life.

Understanding the natural stress response

When you face a perceived threat, a tiny region at the brain's base, called the hypothalamus, sets off an alarm system in the body. An example of a perceived threat is a large dog barking at you during your morning walk. Through nerve and hormonal signals, this system prompts the adrenal glands, found atop the kidneys, to release a surge of hormones, such as adrenaline and cortisol.

Adrenaline makes the heart beat faster, causes blood pressure to go up and gives you more energy. Cortisol, the primary stress hormone, increases sugar, also called glucose, in the bloodstream, enhances the brain's use of glucose and increases the availability of substances in the body that repair tissues.

Cortisol also slows functions that would be nonessential or harmful in a fight-or-flight situation. It changes immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.

When the natural stress response goes wild

The body's stress response system is usually self-limiting. Once a perceived threat has passed, hormones return to typical levels. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to typical levels. Other systems go back to their regular activities.

But when stressors are always present and you always feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress response system and too much exposure to cortisol and other stress hormones can disrupt almost all the body's processes. This puts you at higher risk of many health problems, including:

• Depression.
• Digestive problems.
• Muscle tension and pain.
• Heart disease, heart attack, high blood pressure and stroke.
• Sleep problems.
• Weight gain.
• Problems with memory and focus.

That's why it's so important to learn healthy ways to cope with your life stressors.

Why you react to life stressors the way you do

Your reaction to a potentially stressful event is different from everyone else's. How you react to your life stressors is affected by such factors as:

• Genetics. The genes that control the stress response keep most people at a fairly steady emotional level, only sometimes priming the body for fight or flight. More active or less active stress responses may stem from slight differences in these genes.
• Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be especially at risk of experiencing high stress. The same is true of airplane crash survivors, people in the military, police officers and firefighters, and people who have experienced violent crime.

You may have some friends who seem relaxed about almost everything. And you may have other friends who react strongly to the slightest stress. Most people react to life stressors somewhere between those extremes.

Learning to react to stress in a healthy way

Stressful events are facts of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what causes you stress. And you can learn how to take care of yourself physically and emotionally in the face of stressful situations.

Try these stress management tips:

• Eat a healthy diet and get regular exercise. Get plenty of sleep too.
• Do relaxation exercises such as yoga, deep breathing, massage or meditation.
• Keep a journal. Write about your thoughts or what you're grateful for in your life.
• Take time for hobbies, such as reading or listening to music. Or watch your favorite show or movie.
• Foster healthy friendships and talk with friends and family.
• Have a sense of humor. Find ways to include humor and laughter in your life, such as watching funny movies or looking at joke websites.
• Volunteer in your community.
• Organize and focus on what you need to get done at home and work and remove tasks that aren't needed.
• Seek professional counseling. A counselor can help you learn specific coping skills to manage stress.

Stay away from unhealthy ways of managing your stress, such as using alcohol, tobacco, drugs or excess food. If you're worried that your use of these products has gone up or changed due to stress, talk to your health care provider.

There are many rewards for learning to manage stress. For example, you can have peace of mind, fewer stressors and less anxiety, a better quality of life, improvement in conditions such as high blood pressure, better self-control and focus, and better relationships. And it might even lead to a longer, healthier life.

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• How stress affects your health. American Psychological Association. https://www.apa.org/topics/stress/health. Accessed March 19, 2021.
• Stress effects on the body. American Psychological Association. https://www.apa.org/topics/stress/body. Accessed March 19, 2021.
• Lower stress: How does stress affect the body? American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/lower-stress-how-does-stress-affect-the-body. Accessed March 18, 2021.
• Stress and your health. U.S. Department of Health & Human Services. https://www.womenshealth.gov/mental-health/good-mental-health/stress-and-your-health. Accessed March 18, 2021.
• AskMayoExpert. Stress management and resiliency (adult). Mayo Clinic. 2019.
• Seaward BL. Essentials of Managing Stress. 5th ed. Jones & Bartlett Learning; 2021.
• Seaward BL. Managing Stress: Skills for Self-Care, Personal Resiliency and Work-Life Balance in a Rapidly Changing World. 10th ed. Jones & Bartlett Learning; 2022.
• Olpin M, et al. Stress Management for Life. 5th ed. Cengage Learning; 2020.
• Hall-Flavin DK (expert opinion). Mayo Clinic. March 23, 2021.

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Effects of Stress on Health, Essay Example

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The editors of the Harvard Health letter maintain that there is evidence that individuals who are chronically stressed possess an increased risk of cancer and heart disease.  Although concrete evidence may not be available to substantiate this claim, other researchers and medical professionals continue to argue that the negative effects of stress are quite harmful on the human body.  “Stress is known to significantly alter one’s health, affecting such areas as immune function, heart disease, and susceptibility to cancer” (“Effects of Stress”, 2009, p. 9).  It is clear that stress can dangerously lower the immune system and force the body to be ill equipped to defend itself against harmful disease-causing agents.  Furthermore, research also shows that “stress decreases uterine receptivity by a pathway that is independent of the ovary in infertile women, state researchers in Japan” (“Effects of Stress”, 2009, p. 9).  In other words, it has been proven that stress can make women infertile or at least make the process of conceiving a child much more difficult than in ideal circumstances.  These negative health effects caused directly or indirectly by stress are clear examples that stress does harm the health of human beings each and every day.

However, a study by Coventry et al. (2009) showed marked results that the addition of stress had no negative or positive impact in males or females upon contracting cases of depression (p. 487).  This could be a case to support the claims of author Christopher Caldwell who argues that no one including doctors, can come to an agreement on what stress is, so stress can not be blamed as the cause of disease.  On the other hand, this is a separate case study designed only to examine the impact that stress has on contracting, maintaining and advancing cases of depression.  The case does not support that stress is not a causal agent for other health defects including those mentioned above such as chronic heart disease, immune deficiency and cancer.

I believe that stress is a definite causal factor for health problems in everyday life.  We live a hectic lifestyle that forces many people to get little sleep and have heightened stressful experiences.  I have had a case on Mono and brief period of back spasms that the doctors always told me were caused directly by stress.  When stress increases, I get tired and sometimes even exhausted.  Exhaustion reduces the immune system and can allow for harmful bacteria and viruses to enter the body and cause great damage.  Sometimes people with healthier immune systems are more likely to not experience these effects rather than people with unhealthier lifestyles that reduce the immune system.  Nobody can tell for sure when someone will become ill due to stress; however, it is clear that under the right circumstances stress can cause much damage to the human body.

To avoid stress, I do whatever I can to try to have a healthy outlet for any stress that I experience in everyday life.  For instance, I try to work out at least three times a week.  I know that we are supposed to work out more than that, but with a busy lifestyle it is difficult to fit exercise in each day.  Nevertheless, exercise is a great productive outlet for stress that reduces the stress levels significantly and keeps the body healthy, which also keeps the immune system strong.  I also make it a point to resolve any issues that I experience in my life as much as possible.  When people have stressful issues in their lives that go unresolved, it can continue to increase the stress levels and be very unhealthy.  If I have arguments with friends or feel disrespected, I try to have a constructive conversation to resolve any problems and keep my stress levels low.  This is great when I do not have to constantly worry about situations and problems in my life.  We have enough to worry about; I would much rather not become a victim of stress because of a hectic lifestyle and increased stress levels due to my own inaction.

(2009). Effects of Stress. Fertility Weekly , 9. Retrieved from Academic Search Complete database.

(2009). Stress Adds to Overweight Worries. Tufts University Health & Nutrition Letter , 27 (8), 8. Retrieved from Academic Search Complete database.

Coventry, W., Medland, S., Wray, N., Thorsteinsson, E., Heath, A., & Byrne, B. (2009). Phenotypic and Discordant-Monozygotic Analyses of Stress and Perceived Social Support as Antecedents to or Sequelae of Risk for Depression. Twin Research & Human Genetics , 12 (5), 469-488. doi:10.1375/twin.12.5.469.

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Stress and Its Adverse Health Effects Essay

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Article Information

Summary of the article, reflection on stress.

The article’s topic is Stress and Health: A Review of Psychobiological Processes. The study was published on 4 th September 2021 in the Annual Review of Psychology journal. The article has been authored by three authors, Daryl O’Connor, Julian Thayer, and Kavita Vedhara. In particular, Daryl O’Connor is affiliated with the School of Psychology at the University of Leeds. The second author, Thayer, has been affiliated with the Department of Psychological Science under the School of Social Ecology. The third author, Vedhara, is affiliated with the School of Medicine at the University of Nottingham. The article is a peer review, mainly accomplished by studying numerous articles.

The accumulative science connecting stress to adverse health impacts is massive. Stress can impact health directly via autonomic and neuroendocrine responses and indirectly via modifications in health conduct. Moreover, the studies researched within this article affirm that stress affects various biological schemes and that these systems interrelate with each other to familiarize and react to shifting ecological demands that are alleged as stressful (O’Connor et al., 2021). For instance, the authors have unearthed a thrilling advance in stress and health research concerning examining cortisol in hair. Hair cortisol delivers another biomarker of HPA initiation free from various restrictions of other biological measures. After detecting glucocorticoids in hair by 2004, scholars have investigated the reliability and validity of hair cortisol assessment (O’Connor et al., 2021). The study found that a one-centimeter segment delivers an amount of normal cortisol secretion in the past month, as a 3-cm hair portion gives an amount of cortisol discharge in the past three months. Thus, hair cortisol is a dependable pointer of chronic stress and strongly influences body mass index (BMI), increased blood pressure (BP), diabetes, and adiposity.

I have learnt that stress is a normal experience, as controlled amount has its advantages and cons, but, but what matters the most is how one deals with it. People undergo increased stress, and this adversely affects their lives. More particularly, I have learned about the precise infections caused by stress. For instance, when stress increases or is prolonged, the dangers of mental health challenges and medical complications arise. Long-term stress contributes to psychological disorders, such as anxiety, depression, and sleep complications. Prolonged stress also enhances the danger of medical complications, for instance, headaches, gastrointestinal challenges, deteriorated immune system, high BP, and cardiovascular infection.

In my life, I expect stressors from my education, family, and relationships. Therefore, I plan to exercise more. Sharif et al. (2018) show that physical activity upsurges one’s whole health and sense of well-being, which places more energy in daily life. In other words, physical activities assist enhance the creation of the brain’s feel-good neurotransmitters, identified as endorphins. More specifically, I will engage in daily routines of morning and evening runs, side planks, pushups as well as lunges. Thus, by improving my exercises, I hope to eliminate stress’s physical and mental effects.

O’Connor, D., Thayer, J., & Vedhara, K. (2021). Stress and health: A review of psychobiological processes . Annual Review of Psychology , 72 , 663–688. Web.

Sharif, K., Watada, A., Bragazzid, N., Lichtbroun, M., Amitala, H., & Shoenfeldbc, Y. (2018). Physical activity and autoimmune diseases: Get moving and manage the disease . Autoimmunity Reviews , 17 (1), 53–72. Web.

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IvyPanda. (2023, December 11). Stress and Its Adverse Health Effects. https://ivypanda.com/essays/stress-and-its-adverse-health-effects/

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IvyPanda . "Stress and Its Adverse Health Effects." December 11, 2023. https://ivypanda.com/essays/stress-and-its-adverse-health-effects/.

The Impact of Stress on Health: Learning to Cope

Stress can have serious health implications, increasing the risk of cardiovascular disease and exacerbating medical conditions such as asthma, diabetes, and hypertension. Stress is unavoidable, but learning to manage it effectively is critical.

Stress is a fact of life and can affect individuals in a variety of ways. At some point in life, every individual experiences some degree of stress; some individuals experience stress more often than others and some have difficulty dealing with stress. Stress can be manifested from any situation or thought that causes an individual to experience frustration, anger, and nervousness, whereas anxiety is a feeling of fear and apprehension. 1

Although many individuals manage stress relatively well, some individuals experience physical and/or psychological symptoms. There are times when stress, in limited amounts, can be beneficial and encourages an individual to meet a deadline or get a task done. Studies have shown, however, that individuals who experience excessive amounts of stress may exacerbate or increase the risk of developing various medical conditions. Examples of physical symptoms related to stress include fatigue, headache, gastrointestinal (GI) upset, muscle tension, episodes of dizziness, weight loss or gain, back pain, and teeth grinding. 2,3 Psychological symptoms related to stress include irritability, anger, depression, nervousness, and anxiety. In addition, many individuals experience problems sleeping. 2,3

Forms of Stress

According to the American Psychological Association (APA), stress can be categorized as acute, episodic acute, and chronic. 4

Acute Stress

Acute stress is the most common form of stress and is short term. It is described as a reaction to an immediate threat, commonly referred to as the fight or flight response. 4,5 Common causes of acute stress include noise, danger, crowding, or isolation. 5

Episodic Acute Stress

Episodic acute stress is prevalent among those individuals whose lives are constantly chaotic and demanding. 4,5 These individuals are always in a rush and tend to take on too many tasks at one time. 4,5 Individuals who worry a lot are also prone to episodic acute stress. 4

Chronic Stress

Chronic stress is defined as a type of stress that occurs over a long period of time from either internal or external stressors. 4 Common causes of chronic stress include financial problems, death of a loved one, long-term relationship issues, or having a demanding job or work schedule. 5

Effects of Stress

Stress has been linked to or can exacerbate various medical conditions, such as asthma, fatigue, back pain, arrhythmias, difficulty breathing, headaches, hypertension, irritable bowel syndrome, ulcers, suppression of the immune system, and fluctuations in blood glucose levels in diabetic patients. 4-9 Both emotional and physical stress can have a significant negative impact on the heart and vascular system. 4-9 Chronic stress has been shown to increase an individual’s heart rate and blood pressure, thus making the heart work harder than normal. 4-9 Some studies suggest that the inability to manage stress can be associated with the onset of depression or anxiety and that the repeated release of stress hormones can cause hyperactivity in the hypothalamic-pituitary-adrenal system. This can disrupt normal levels of the neurotransmitter serotonin, which is critical for feelings of well-being. 5

Various studies also report that stress can also cause hives and atopic dermatitis. 5-9 Stress can impact the GI system, causing or exacerbating conditions such as gastroesophageal reflux disease, peptic ulcers, and ulcerative colitis. 5-9 Stress also seems to increase the frequency and severity of migraine headaches. There is scientific evidence indicating that individuals experiencing psychological stress are more prone to developing colds and other infections than their less-stressed peers. 5-9

Cardiovascular Disease Risk

While more research needs to be conducted, the American Heart Association reports that various studies suggests that there is a link between the risk of cardiovascular disease and environmental and psychosocial factors. 10 Examples of these factors include job strain, social isolation, and personality traits. It is not known if stress acts as an “independent” risk factor for cardiovascular disease. 10 Both acute and chronic stress may affect other risk factors and behaviors, such as elevated blood pressure and cholesterol levels, smoking, physical inactivity, and overeating. 10

Sources of Stress

According to statistics from an APA poll conducted in 2007 entitled “Stress in America,” more than 33% of individuals in the United States report experiencing high levels of stress, and more than 1 in 5 individuals report experiencing high levels of stress 15 days or more each month. 2

Furthermore, an estimated 48% of Americans believe that their individual stress levels have increased over the past few years. The poll identified money and work as some of the leading causes of stress, and 51% report that the housing crisis was a major cause of stress. 2 In addition to affecting health, stress can affect both personal and work relationships and productivity at work. 2

Numerous studies show job stress is considered to be the greatest source of stress among adults in the United States and that levels of stress have increased significantly over the past few decades. 11

In a report published in the November 24, 2009, online edition of the Journal of Epidemiology and Community Health, a study concluded that men who consistently failed to deal with work-related stress issues were twice as likely to have a myocardial infarction or die of cardiovascular disease than those who managed stress in a constructive way. 12

Occupational Stress in Health Care

According to the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health, occupational stress has been a concern of the health care industry for a long time. 2 Results from several studies indicate that health care workers may have increased rates of stress compared with other professions as well as increased rates of depression and anxiety that are directly related to job stress. 2 Furthermore, in addition to psychological distress, other by-products of job stress for the health care field include burn out, absenteeism, decreased patient satisfaction, and diagnosis and treatment errors. 2 Examples of factors contributing to stress that are common in the health care profession include inadequate staffing levels, long work hours, demanding schedule with little or no breaks, and potential exposure to infectious and/or hazardous substances. 2

In general, workplace factors that may contribute to or exacerbate levels of stress include 2 :

• Job demands (work overload)

• Financial and economic factors

• Conflict between work and family roles and responsibilities

• Lack of opportunity for growth or promotion

Pharmacists are in a pivotal position to identify those patients at risk for stress and anxiety disorders such as those dealing with a chronic illness such as diabetes, cardiovascular disease, cancer, stroke, Parkinson’s disease, or multiple sclerosis, or caregivers of those with medical conditions such as Alzheimer’s disease or cancer. During counseling, pharmacists should take the opportunity to remind patients about the effects of stress on overall health. For example, according to the American Diabetes Association, stress can affect patients with diabetes in 2 ways 13 :

• Stress hormones may change blood glucose levels directly.

• When under stress, individuals may drink more alcohol or exercise less, and may forget or not have time to monitor glucose levels or adhere to diet plans.

The management of stress should be individualized and based on the severity, type, and frequency of stress. Cognitive behavioral therapy is considered to be one of the most effective means of reducing stress. 5,14 The Table highlights techniques to prevent and manage stress. Patients experiencing chronic stress or displaying symptoms related to anxiety disorders, such as posttraumatic stress disorder, should always be referred to their primary health care provider for further assessment and treatment.

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The unique toll of stress and depression on women’s hearts

A growing body of evidence suggests the effects of mental health have a disproportionate impact on women’s bodies.

Dianne Travis-Teague remembers clutching her chest as she navigated the chaos of a crowded hospital parking lot, searching for a space amid the throng of vehicles. For weeks a clinic in her hometown of Santa Barbara had been telling her the chest pain was merely the result of anxiety or indigestion.

At the emergency room, doctors quickly discovered that the two-time breast cancer survivor was having a heart attack. Surgery to unblock her arteries saved her life, but for the next four months, her pain continued. “I was feeling worse off after the stent than before,” she said. “I suffered, sometimes silently. My family suffered as well.”

It wasn’t until she visited a women’s heart specialist that she found answers. Her doctor asked questions about her life, family and stress related to her work as the director of alumni relations at a graduate school. Her physician, C. Noel Bairey Merz, director of ​​ the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, also explained the link between mental and cardiac health, especially in women.

Bairey Merz prescribed a new blood pressure medication and a lifestyle regimen focused on stress reduction. Travis-Teague was feeling better within a few weeks.

“It was like all of a sudden, somebody could hear me,” Travis-Teague said. “Now I know the importance of work-life balance.”

Why stress affects women’s hearts

A growing body of evidence suggests the effects of mental health has a disproportionate impact on women’s bodies. Recent findings presented at the American College of Cardiology’s Annual Scientific Session in April indicate that depression and anxiety accelerate the development of new cardiovascular disease risk factors, particularly among young and middle-aged women.

The researchers followed 71,214 people participating in the Mass General Brigham Biobank for 10 years. Those with a history of anxiety or depression before the study were about 55 percent more likely to develop high blood pressure, high cholesterol or diabetes compared to those without. The finding was most pronounced among women with anxiety or depression who were under 50, who were nearly twice as likely to develop cardiovascular risk factors compared with any other group.

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“The aim of our project is to suggest that if a physician has a patient with anxiety or depression, he or she should also think about screening for cardiovascular risk factors,” said lead author Giovanni Civieri, a cardiologist and research fellow at Massachusetts General Hospital and Harvard Medical School.

Previous studies have also shown that stress and emotional health can have an outsize impact on women’s hearts.

One study of more than 3,600 men and women from Framingham, Mass. , looked at married partners who typically bottled up their feelings during a fight with their spouse. Women who “self-silenced” during marital conflict were four times as likely to die during the 10-year study period as women who always spoke their mind. (The effect wasn’t seen in men.) Whether the woman reported being in a happy marriage or an unhappy marriage didn’t change her risk.

An 18-year study of 860 Australian women concluded that having a depressive disorder is a risk factor for coronary heart disease in women. The strength of association between depression and heart disease was of a greater magnitude than any other risk factor.

“The literature supports an even stronger association between depression and heart disease and bad outcomes in women than men,” said Roy Ziegelstein, a cardiologist and professor of medicine at Johns Hopkins.

Ziegelstein pointed to a condition called Takotsubo cardiomyopathy — also known as “stress cardiomyopathy” or broken heart syndrome — that is more common in women. As many as 90 percent of cases occur in women between the ages of 58 and 75 . While many people recover, the condition can be life-threatening and is often triggered by intense physical or emotional stress.

Across the spectrum of age, ethnicity and socioeconomic status, there are numerous tales of women whose symptoms are ignored, only to later discover that they have experienced a heart attack or developed cardiovascular disease.

For Marianna Knopov, several New York physicians she saw over three years were unable to pinpoint the cause of her intense heart palpitations and chest tension. In 2013, the then 51-year-old Russian immigrant was a busy mother of two teenage sons steering her own thriving dental clinic. “My life was basically like a roller coaster,” she said.

After years of the same cycle — pain, hospitals and home without relief — Knopov said she was ready to give up on her search for answers. “You go to one after another and they don’t listen to you. They don’t hear you. They just want to dismiss you, and that’s how I felt.”

By the time she met Evelina Grayver in 2016, a cardiologist specializing in women’s heart health who is now at Katz Institute for Women’s Health at Northwell Health in Queens, the vessels in her heart had become constricted and calcified, and there was “absolutely nowhere” to attach a new bypass.

Doctors placed seven stents in all three of her major arteries — and Grayver prescribed a lifestyle regimen to better regulate the anxiety and chronic stress that helped get her there. Knopov said the diagnosis had a “profound” effect on her. “I had to change something,” she said.

She eventually sold her practice, traded in New York’s bustling streets for Florida’s serene beaches, and recently became a grandmother.

“I’m living a totally different life,” she said. Now 62, Knopov has incorporated meditation, yoga and abdominal breathing exercises into her daily routine, and she walks 10,000 steps per day.

Knopov said her doctors’ advice helped her “experience a different state of mind and being.” There is a lot of joy each day,” she said.

Inside women’s hearts

In the intricate web of mental health and cardiovascular well-being, there isn’t a clear explanation why the connection is so strong in women.

Studies from Emory University have found that women experiencing acute mental stress are more susceptible than men to constriction of their small peripheral arteries , leading to diminished blood flow. Researchers found that the microvascular response to stress was also associated with adverse outcomes in women but not in men.

One reason for this could be that women’s blood vessels are smaller in caliber and consistency than those found in men. While men are prone to centralized plaque buildup in the largest arteries that supply blood to the heart, women typically have diffused, small blockages throughout their blood vessels, “which is very dangerous” because they can be more difficult to detect and treat, according to Grayver.

Additionally, experts say stress in women appears to disrupt lipid balance, increase platelet aggregation and impair glucose regulation. Chronic stress may further exacerbate coronary heart disease progression by fueling inflammation, a risk factor more pronounced in women . This heightened inflammatory response elevates their chances of major adverse cardiovascular events.

“We know that anxiety and stress and depression are bad. Now, let’s figure out how to best identify and treat people who are at risk,” said Puja Mehta, director of women’s translational cardiovascular research at the Emory Women’s Heart Center. “How do we help them manage stress so that it improves blood flow to the heart?”

One key area of interest for researchers is whether addressing mental health concerns, using existing medications such as antidepressants or traditional talk therapy could mitigate cardiovascular risk. Others are studying a potential genetic link between depression and heart disease, with the hope of discovering novel drugs capable of treating both conditions simultaneously.

After an attack, lowering future risk

While understanding why women’s hearts are particularly vulnerable to stress is valuable, it’s more important for doctors to acknowledge the connection from the outset.

“What tends to happen is that younger women who have risk factors, for example, may only see their OB/GYN for birth control, and by the time they come to the cardiologist they’ve already developed heart disease or heart failure,” Mehta said. “We have to do a better job of identifying and early prevention.”

Following a heart attack, women face a higher risk of mortality within the five years. While not fully understood, one theory suggests that the increased risk could be attributed to the adverse psychological reactions to the stress of experiencing a heart attack, according to JoAnn E. Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.

Research also shows that fewer women than men are referred to cardiac rehabilitation programs , which can help limit the psychological stresses associated with cardiac disease, reduce the risk of associated mortality and improve cardiovascular function to help patients optimize their quality of life. In addition, women are less likely to be put on protective medications , such as cholesterol-lowering statins or beta blockers, to protect against future cardiovascular events.

Experts emphasize that lifestyle interventions are among the most effective and accessible tools for women managing both mental health and cardiovascular conditions. That includes regular exercise, improved diet and sleep patterns, as well as tools to manage stress, such as meditation and deep breathing.

Social support also seems to have a stronger heart benefit for women compared with men. The presence of family members or friends with whom women can maintain regular contact strongly predicts their cardiovascular health, according to Manson.

Travis-Teague has continued to work with her doctors to manage her stress. Her advice to women facing similar challenges: “Understand that you need to listen to your body and be your own advocate. Do not be afraid to ask questions and to find the place where people will care for you.”

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Does Stress Cause Ulcers?

Here’s what the evidence suggests about this long-running claim.

Credit... Eric Helgas for The New York Times

Supported by

By Melinda Wenner Moyer

• June 17, 2024

Q: My family always says I’m going to give myself an ulcer if I don’t manage my stress. But is that really a thing?

Although people have long believed — and doctors used to claim — that stress can cause stomach ulcers, the relationship between the two is not straightforward, experts say.

It’s true that some critically ill patients, like those admitted to intensive care units, can develop stress ulcers , which are sores in the lining of the gastrointestinal tract that quickly arise after extreme physical stress. But “there is simply no data” confirming that everyday psychological stress can directly cause ulcers, said Dr. Tonya Adams, a gastroenterologist at Gastro Health in Fairfax, Va.

That said, it’s possible that, among people who are at high risk for developing ulcers for other reasons, such as overusing specific medications or being infected with a certain type of bacteria, stress could tip them over the edge, said Dr. Neha Mathur, a gastroenterologist at Houston Methodist Hospital.

The Complex Role of Stress

A common type of ulcer — called a peptic ulcer — forms when stomach acid erodes the protective lining of the stomach or the small intestine, causing sores to develop, said Dr. Carolyn Newberry, a gastroenterologist at NewYork-Presbyterian. Another type, known as a gastric ulcer, forms when the sores develop in the stomach lining specifically.

Researchers estimate that about 5 to 10 percent of people worldwide will develop an ulcer.

Most people with peptic ulcers do not have symptoms, Dr. Mathur said. But some can have upper abdominal pain, upset stomach, heartburn, bloating or nausea. Some ulcers also bleed, causing dark, tar-like stools or stools tinged with bright red blood.

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