|
Problems
Associated With Stress
Stress responses are potentially harmful, especially if they
are severe or extend over a long period of time. When stressors
end up leading to stress responses, a number of problems can
arise, such as burnout, mental disorders, and physical
illnesses. Moreover, stress responses, such as emotional
responses like anxiety and worry and cognitive responses like
having a poor or hopeless attitude, can even worsen any pain that
people may be feeling (99).
A. Burnout
Burnout is an increasingly intense pattern of psychological,
physiological, and behavioral dysfunction in response to a
continuous flow of stressors or chronic stress (110; 142).
It is commonly found among employees and professionals who have a
high degree of personal investment in work and high performance
expectations. In the initial stages, people often have a variety
of physiological and behavioral symptoms and lose interest and
confidence in their work. The following physiological symptoms
may occur:
- Shortness of breath
- Loss of appetite or weight
- Headache
- Fatigue and exhaustion
The following behavioral symptoms may occur:
- Lack of interest in fellow employees
- Risky behavior
- Mood swings
In the later stages, people often do the following things:
- Abuse alcohol and other drugs
- Smoke excessively
- Drink more caffeinated beverages
- Become more rigid in their thinking
- Lose faith in the abilities of co-workers, management,
the organization, and themselves
- Become less productive (117)
Another concept, ego depletion, is very similar to
burnout. In fact, it may represent an underlying feature of
burnout. The idea behind ego depletion is that acts of
volition—making choices and decisions, taking
responsibility, initiating and inhibiting behavior, and making
plans of action and carrying them out—draw on a limited
supply of volitional energy that is available inside people.
Consequently, if people deplete this resource too much, it is no
longer very easy to do what they need to do to handle stress,
such as trying to use coping strategies in response to stressors (14).
B. Mental Disorders
Mental disorders are the result of a varying combination of
sources, one of which being stress. Examples of other sources are
as follows:
- Chemical imbalances
- Inherited characteristics
- Early learning experiences
- Brain damage
- Psychological traits
The diathesis-stress model explains how stress
contributes to the onset of mental disorders. According to this
model, chemical imbalances, inherited characteristics, and early
learning experiences can make it more likely for people to get
mental disorders but whether they do depends on the stressors
they encounter (114).
People sometimes have symptoms of mental disorders, but they
usually do not meet the criteria or are not clinically
significant, severe enough to necessitate treatment. Before a
person can be diagnosed with a mental disorder, his or her
problematic thoughts, feelings, and actions must meet the
criteria for the mental disorder and must prevent adequate
social, occupation, or other forms of functioning (7).
Accordingly, answering yes to any of the following
questions may suggest clinical significance:
- Is the behavior considered strange within the person's
own culture?
- Does the behavior cause personal distress?
- Does the behavior interfere with what the person is
trying to accomplish?
- Is the person a danger to self or others?
- Is the person legally responsible for his or her acts? (177)
Stress may play a causal role in a wide variety of mental
disorders. Some of the mental disorders in which stress appears
to have a causal role are anxiety disorders, mood
disorders, and substance-related disorders.
1. Anxiety
Disorders
Anxiety disorders are characterized by anxiety, either as the
primary symptom or the primary cause of other symptoms (80).
The presence or absence of panic attacks or agoraphobia
is a critical aspect of several disorders. A panic
attack " is a discrete period in which there is the sudden
onset of intense apprehension, fearfulness, or terror, often
associated with feelings of impending doom. During these attacks,
symptoms such as shortness of breath, palpitations, chest pain or
discomfort, choking or smothering sensations, and fear of 'going
crazy' or losing control are present" (7, p. 393).
Agoraphobia "is anxiety about, or avoidance of, places or
situations from which escape might be difficult (or embarrassing)
or in which help may not be available in the event of having a
Panic Attack or panic-like symptoms" (7, p. 393).
Twelve different anxiety disorders can be diagnosed:
- Panic disorder without agoraphobia "is
characterized by recurrent unexpected Panic Attacks about
which there is persistent concern" (7, p. 393).
- Panic disorder with agoraphobia "is
characterized by both recurrent unexpected Panic Attacks
and Agoraphobia" (7, p. 393).
- Agoraphobia without history of panic disorder "is
characterized by the presence of Agoraphobia and
panic-like symptoms without a history of unexpected Panic
Attacks" (7, p. 393).
- Specific phobia "is characterized by
clinically significant anxiety provoked by exposure to a
specific feared object or situation, often leading to
avoidance behavior" (7, p. 393).
- Social phobia "is characterized by clinically
significant anxiety provoked by exposure to certain types
of social or performance situations, often leading to
avoidance behavior" (7, p. 393).
- Obsessive-compulsive disorder "is
characterized by obsessions (which cause marked anxiety
or distress) and/or by compulsions (which serve to
neutralize anxiety)" (7, p. 393).
- Posttraumatic stress disorder "is
characterized by the reexperiencing of an extremely
traumatic event accompanied by symptoms of increased
arousal and by avoidance of stimuli associated with the
trauma" (7, p. 393).
- Acute stress disorder "is characterized by
symptoms similar to those of Posttraumatic Stress
Disorder that occur immediately in the aftermath of an
extremely traumatic event" (7, p. 393).
- Generalized anxiety disorder "is
characterized by at least 6 months of persistent and
excessive anxiety and worry" (7, p. 393).
- Anxiety disorder due to a general medical condition "is
characterized by prominent symptoms of anxiety that are
judged to be a direct physiological consequence of a
general medical condition" (7, p. 394).
- Substance-induced anxiety disorder "is
characterized by prominent symptoms of anxiety that are
judged to be a direct physiological consequence of a drug
of abuse, a medication, or toxin exposure" (7,
p. 394).
- Anxiety disorder not otherwise specified is used
as a diagnosis when anxiety symptoms do not meet the
criteria for other disorders or when there is inadequate
or contradictory information about anxiety symptoms (7).
Regarding the causal role of stress in anxiety disorders,
stressors appear to have a causal influence (12; 101).
The specific way in which stressors lead to the onset of anxiety
disorders, however, varies depending on the type of anxiety
disorder (55). Additionally, posttraumatic stress
disorder can be thought of as a prolonged and severe stress
response to a catastrophe or to a chronic intense stressor (177).
2. Mood
Disorders
Mood disorders involve disturbances in mood that range from
depression to mania (80). The number of major
depressive episodes, manic episodes, mixed episodes, or hypomanic
episodes is a critical aspect of several mood disorders.
Major depressive episodes involve "at least 2 weeks of
depressed mood accompanied by a characteristic pattern of
depressive symptoms" (63, p. 194). Mixed episodes
involve "at least 1 week of elevated, euphoric, or irritable
mood accompanied by a characteristic pattern of manic
symptoms" (63, p. 194). Mixed episodes involve
"at least 1 week of a mixture of manic and depressive
symptoms" (63, p. 194). Hypomanic episodes
involve "at least 4 days of elevated, euphoric, or irritable
mood that is less severe than a manic episode" (63, p.
194).
Ten different mood disorders can be diagnosed:
- Major depressive disorder "is characterized
by one or more Major Depressive Episodes" (7,
p. 317).
- Dysthymic disorder "is characterized by at
least 2 years of depressed mood for more days than not,
accompanied by additional depressive symptoms that do not
meet criteria for a Major Depressive Episode" (7,
p. 317).
- Depressive disorder not otherwise specified is
used as a diagnosis when the depressive symptoms do not
meet the criteria for other disorders or when there is
inadequate or contradictory information about the
depression symptoms (7).
- Bipolar I disorder "is characterized by one
or more Manic or Mixed Episodes, usually accompanied by
Major Depressive Episodes" (7, p. 317).
- Bipolar II disorder "is characterized by one
or more Major Depressive Episodes accompanied by at least
one Hypomanic Episode" (7, p. 318).
- Cyclothymic disorder "is characterized by at
least 2 years of numerous periods of hypomanic symptoms
that do not meet criteria for a Manic Episode and
numerous periods of depressive symptoms that do not meet
criteria for a Major Depressive Episode" (7, p.
318).
- Bipolar disorder not otherwise specified is used
as a diagnosis when the bipolar symptoms do not meet the
criteria for other disorders or when there is inadequate
or contradictory information about the bipolar symptoms (7).
- Mood disorder due to a general medical condition
"is characterized by a prominent and persistent
disturbance in mood that is judged to be a direct
physiological consequence of a general medical
condition" (7, p. 318).
- Substance-induced mood disorder "is
characterized by a prominent and persistent disturbance
in mood that is judged to be a direct physiological
consequence of a drug of abuse, a mediation, another
somatic treatment for depression, or toxin exposure"
(7, p. 318).
- Mood disorder not otherwise specified is used as a
diagnosis when the mood symptoms do not meet the criteria
for other disorders or when there is inadequate or
contradictory information about the mood symptoms (7).
Regarding the causal role of stress in mood disorders,
negative major life events tend to precede depression (177).
In fact, compared to the number of negative major life events
experienced by people who are not depressed, people who become
depressed experience two to three times as many shortly
beforehand (73).
3.
Substance-Related Disorders
Substance-related disorders are characterized by the use of
drugs like alcohol, cocaine, heroin, and other substances people
use to alter the way they think, feel, and act (13).
Substance-related disorders fall into two categories: substance
use disorders and substance-induced disorders.
Substance use disorders are characterized by a problematic
pattern of substance use, involving dependence on or abuse of
substances. Substance-induced disorders are characterized by
reactions to the effect of substances on the central nervous
system, involving intoxication, withdrawal, and sets of
substance-induced features that resemble other disorders (63,
1995). Regarding the causal role of stress in
substance-related disorders, the need to reduce stress may be one
of the initial causes of substance abuse (23).
C. Physical Illnesses
Stress is a health hazard. Stress can lead to a variety of
physical illnesses and related health problems. In fact, stress
has a negative impact on virtually every organ system in the
body:
- Cardiovascular system
- Respiratory system
- Endocrine system
- Gastrointestinal tract
- Male and female reproductive systems
- Immune system (81)
Some physical illnesses, such as peptic ulcers, are caused by
physiological responses to stressors. Other physical illnesses,
such as asthma and skin rashes, however, can occur in the absence
of stress but are aggravated by it. Regarding the changes in body
chemistry that accompany physiological responses to stressors,
increased levels of glucocorticoids are usually more harmful to a
person's health than are increased levels of epinephrine and
norepinephrine. Prolonged exposure to high levels of
glucocorticoids can lead to the following problems:
- Increased blood pressure
- Damaged muscle tissue
- Infertility
- Inhibitted growth
- Immune system suppression
- Brain damage
- Accelerated aging (31)
In particular, stress appears to be a cause of immune
system suppression and cardiovascular diseases and
an influence on the course of cancer.
1. Immune
System Suppression
Physiological response to stressors can impair the function of
the immune system, which leaves people vulnerable
illness-promoting substances like viruses, bacteria, and fungi.
When a married person dies, for example, it is often the case
that his or her spouse dies soon afterward from an infection (31).
Additionally, people who are more stressed are more likely to
catch a cold than are people who are less stressed, for example (36;
37).
2.
Cardiovascular Diseases
Cardiovascular diseases typically involve high blood pressure
and a high level of cholesterol in the blood. People with
cardiovascular diseases are prone to have heart attacks and
strokes (31). A certain pattern of psychological
responses to stressors, referred to as cynical hostility,
is a risk factor for coronary heart disease and heart attacks (153).
Cynical hostility is characterized by the following thoughts and
feelings:
- Suspiciousness
- Resentment
- Frequent anger
- Antagonism
- Distrust of others (154; 176)
3. Cancer
Although stress may not cause cancer, it can contribute to it
by weakening the body's natural defenses against cancerous cells (86).
Furthermore, this influence may be particularly strong for people
who have major depression, feel hopeless, and are indifferent
toward the pain (38). For example, mastectomy patients
who are determined to overcome their breast cancer tend to be
more likely to survive than mastectomy patients who feel hopeless
and are indifferent toward the pain tend to be (75; 124).
|
