Could stress be killing you?


Stress is an evolutionary adaptive behaviour designed to repurpose the body's resources best to avoid threat. A number of physical and chemical reactions are designed to work in discrete bursts to promote survival.  Chronic stress is linked with increased mortality, physical and mental illness.  People under intense stress live shorter lives, are less happy and may not even have warning symptoms. Chances are that if you are reading this article, you are worried and looking for ways to reduce stress.

Causes and personality types

Stress is perceived; that is, any stimulus can present a threat, and this perception is individual. Spiders are a threat to some more than a deadline.  Stress may be due to one event or many. The brain interprets information in the context of prior experience to enable innate reactions to those perceived as a threat.

If something worries you, it usually has some past significance. The brain activates a number of expert centres, including the limbic system, to instil fear and anxiety in the face of danger. Blood is diverted to the legs and brain, the heart rate and strength increases, and adrenaline floods the body.  We are primed to this 'fight or flight'response.

This technique is useful when it can be used, but in the 21st century our stressors cannot be escaped, and we must deal with the long-term effects of the activation of this system.  Research has shown that the hormones released during stress have known effects such as increased blood pressure, metabolic release of fats and sugars, suppression of the immune system and the activation of neural and cognitive circuits that lead to depression and anxiety.

Some personality types, defined as 'Type A' in a study by cardiologists, are more susceptible to generating a stress response and therefore experience the long term effects. This may be due to genetic, social or psychological reasons. Competitive, rigid and self-judging people tend to find themselves more stressed than others, and are more likely to generate significant responses. This may be due to relative inability to accept limitation or loss. The classic picture is one of a middle-aged, overweight angry businessman, but stress can be found in every echelon of society and work and is on the rise.

What are the symptoms of stress?

Stress symptoms can be explained as either 'acute' (i.e. at the time of a stress response) or 'chronic' (the long-term effects of stress on the body.) Acute symptoms are brought about by the interplay of hormones and the body's physiology (its physical and chemical machinery and interactions.)

These include fear, anxiety, nausea, gastric discomfort, increased and heavy heart rate, feels of numbness and feeling 'unreal' and may progress to panic and a fear of death. These changes are familiar to anyone who has waited for exam results or has been given terrible news.

Long-term symptoms are subtle and may reflect chronic changes occurring in the body. Chest or limb pain on exertion may signify vascular disease as a result of high blood pressure. If you experience these symptoms, you must seek medical help. Headaches, muscle aches and soreness may indicate tension. Irritability, sadness, sleep disturbance, poor memory, concentration and nervousness may indicate depression or anxiety disorders. Post-traumatic stress disorder (PTSD) is a complex reactive syndrome beyond the scope of this work.

'Functional' body changes occurring as a result of hormonal irregularities may result in bowel symptoms, joint aches, atypical chest pains and chronic headaches. Immune suppression, due to a complex interplay between metabolic substances released by stress, increases a person's risk of infection and duration of illness. Understandably these symptoms can be so general that the stress-related cause may go unnoticed until complex disease has taken irreversible hold as a result of it. It is important to consider stress in the cause of disease.

Why is stress dangerous?

A wealth of research has linked chronic stress to increased risk of death, mainly due to heart disease. The physiological result of stress, high blood pressure and the release of fats/sugars into the blood are known triggers for heart disease. The formation of clots/plaques in the heart arteries is precipitated by high blood pressure and cholesterol, both increased in chronic stress.

Certain cancers are also at an increased risk. Chronic mental health diseases, for example depression, are linked with increased mortality through either mood-related action, substance abuse of associated dietary or health behaviours. Simply put, stress speeds up changes that bring about disease and death, often with no obvious warning other than vague symptoms.

The first manifestation of the long-term changes induced by stress may indeed be a heart attack, so it is prudent to tackle any concern before irreparable damage is done.

How is stress treated?

A long time ago in the past we could avoid our stressors, because we would either run away, kill the threat or be eaten. Chronic stressors, such a work deadlines and family, are harder to avoid, (even though your mother-in-law is unlikely to eat you!)

If you think you may be stressed and feel that it is a problem, I recommend you see a physician to check your overall health and develop a plan for tackling stressful causes.

It may be prudent to check your blood pressure and take blood tests to rule out physical or hormonal causes for symptoms, and suggest any medication in case you have any manifestation of stress. This may include blood pressure medication

Tackling the cause by keeping a diary of your moods can help you identify triggers. Making a plan to avoid or reduce exposure to these situations can be helpful, but developing coping strategies based around acceptance of uncomfortable feelings is helpful. Cognitive therapy, and forms such as 'Mindfulness' are proved to help people develop significant coping mechanisms for stress . The use of exercise, good sleep hygiene, and simply taking better care of yourself has documented benefits in the face of chronic stress.

The first step to tackling stress is accepting that you have the power to fight against it. Well done for taking control.

Dr Ben Janaway MBChB is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter 

Sources:

1)      https://www.mentalhealth.org.uk/a-to-z/s/stress (first accessed 27/7/16)

2)      Simon, C et al (2016) 'Oxford Handbook of General Practice' 4th Edition, Oxford University Press, Oxford

3)      https://www.psychologistworld.com/stress/fightflight.php (first accessed 27/7/16)

4)      www.springer.com/cda/content/document/cda.../9781461455370-c1.pdf (first accessed 27/7/16)

5)      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/ (first accessed 27/7/16)

6)      http://www.ncbi.nlm.nih.gov/pubmed/22271841 (first accessed 27/7/16)

7)      http://www.simplypsychology.org/personality-a.html (first accessed 27/7/16)

8)      http://www.bmj.com/content/345/bmj.e4933 (first accessed 27/7/16)

9)      http://www.nhs.uk/conditions/stress-anxiety-depression/pages/understanding-stress.aspx   (first accessed 27/7/16)