Stress-related disorders

Stress is a conscious or unconscious psychological feeling or physical situation which comes as a result of physical or/and mental 'positive or negative pressure' to overwhelm adaptive capacities.

Stress is a psychological process initiated by events that threaten, harm or challenge an organism or that exceed available coping recourses and it is characterized by psychological responses that are directed towards adaptation.

Stress is wear and tear on the body in response to stressful agents. Hans Selye called such agents stressors and said they could be physical, physiological, psychological or sociocultural. And stress is not an anxiety disorder and it is not a normative concept.

A person typically is stressed when positive or negative (e.g., threatening) experiences temporarily strain or overwhelm adaptive capacities. Stress is highly individualized and depends on variables such as the novelty, rate, intensity, duration, or personal interpretation of the input, and genetic or experiential factors. Both acute and chronic stress can intensify morbidity from anxiety disorders. One person's fun may be another person's stressor. For an example, panic attacks are more frequent when the predisposed person is exposed to stressors.

Stress reduction strategies

Stress-reduction strategies can be helpful to many stressed/anxious person. However, many anxious persons cannot concentrate enough to use such strategies effectively for acute relief. (Most stress-reduction techniques have their greatest utility as elements of a prevention plan that attempts to raise one's threshold to anxiety-provoking experiences.)

A Technique for Promoting the Relaxation Response

For this technique Basic elements such as a quiet environment, a comfortable posture, a mental device (a meaningful word or phrase) and a pacific attitude is used.

After basic elements, in a quiet environment, sitting in a comfortable position eyes are closed and all muscles are deeply relaxed beginning from feet and progressing up to face (i.e., feet, calves, thighs, lower torso, chest, shoulders, neck, hand). Allowing muscles to remain relaxed. Becoming aware of breathing and while breathing out, saying silently the word "one" ("won") or some other word or short phrase that is meaningful (i.e., breathe in; breathe out, saying "won"; breathe in; breathe out, saying "won").

This technique is continued for 20 minutes. Eyes can be opened periodically to check the time, but generally alarm is not used. It is performed once or twice daily and not within 2 hours after any meal.

After finishing each 20-minutes exercise. Sitting quietly for a few minutes, first eyes are shut and then eyes are opened.

The goal here is a passive attitude. Deep relaxation will not always occur, and distracting thoughts might come. When conscious of them, they are ignored and breathing exercise are sustained.

The 5 R's of Stress/Anxiety reduction

There are 5 core concepts which are used in the reduction of anxiety or stress.^[1]

Recognition of the causes and sources of the threat or distress; education and consciousness raising.
Relationships identified for support, help, reassurance
Removal from (or of) the threat or stressor; managing the stimulus.
Relaxation through techniques such as meditation, massage, breathing exercises, or imagery.
Re-engagement through managed re-exposure and desensitization.

Defenses

Summary

The major function of these psychological defenses is to prevent the experiencing of painful emotions. There are several major problems with their use.

First Many of these defenses create new problems that are as bad, or worse, than the emotional problems they mask. Some are just plain destructive.
Example:
Rejection literally destroys the relationships we care most about.

Second These defenses distort our ability to perceive reality as it is. And this prevents us from dealing with our problems in a constructive way.

Third These defenses do not rid us of the painful feelings we have. In fact, by masking them so that we do not feel them, we effectively store them up within ourselves. Emotions are discharged through expression, so by denying ourselves the chance to feel them, we also deny ourselves the ability to get rid of them.

Fourth These defenses do not just screen out painful emotions. They are, in fact, defenses against all emotion. So the more effective our defenses become in protecting us from our painful feelings, the less able we are to experience the joyful and happy feelings that make life worth living.

Finally These defenses are not perfect. As more and more hurt is stored away, a tension is developed. We become increasingly anxious, nervous, and irritable. We become emotionally unpredictable. And when our defenses weaken, as they will from time to time, we experience emotional explosions.

Ultimately These defenses prevent us from knowing what is wrong, but they do not prevent us from feeling bad.

Stress as in Clinical Medicine

Acute stress disorder

Acute stress disorder occurs in individuals without any other apparent psychiatric disorder, in response to exceptional physical/or psychological stress. While severe, such reactions usually subside within hours or days. The stress may be an overwhelming traumatic experience (e.g. accident, battle, physical assault, rape) or unusually sudden change in social circumstances of the individual, such as multiple bereavement. Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions, as evidenced by the fact that not all people exposed to exceptional stress develop symptoms. However, it needs to be remembered that an acute stress disorders falls under the class of an anxiety disorder.

Symptoms

Symptoms show considerable variation but usually include: An initial state of "DAZE" with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, disorientation. Followed either by further withdrawal from the surrounding situation to the extent of a dissociative stupor or by agitating and over activity.

Autonomic signs of "Panic Anxiety"

The signs are: Tachycardia (increased heart rate), Sweating, Hyperventilation (increased breathing). The symptoms usually appear within minutes of the impact of the stressful stimulus and disappear within 2–3 days.

Post-traumatic stress disorder (PTSD)

Main article: Post-traumatic stress disorder

This arises after response to a stressful event or situation of an exceptionally threatening nature and likely to cause pervasive distress (great pain, anxiety, sorrow, acute physical or mental suffering, affliction, trouble) in almost anyone.

Causes

The causes of PTSD are: Natural or human disasters, war, serious accident, witness of violent death of others, violent attack, being the victim of sexual abuse, rape, torture, terrorism or hostage taking.

Predisposing factors The predisposing factors are: Personality traits and Previous history of Psychiatric illness.

Typical symptoms

"Flashbacks" - the repeated reliving of the trauma in the form of intrusive memories or dreams, intense distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma, avoidance of activities and situations reminiscent of the trauma, emotional blunting or "numbness", a sense of detachment from other people, autonomic hyper arousal with hyper vigilance, an enhanced startle reaction and insomnia, marked anxiety and depression and, occasionally, suicidal ideation.

Treatment

Psychiatric consultation: Exploration of memories of the traumatic event, relief of associated symptoms and counseling.

Prognosis

The course is fluctuating but recovery can be expected in the majority of cases. Few people may show chronic course over many years and a transition to an enduring personality change

In surgery

Main article: Surgical stress

Stress ulceration

Stress ulceration is a single or multiple fundic mucosal ulcers which often gives upper gastrointestinal bleeding developed during the severe physiologic stress of serious illness.

Ordinary peptic ulcers are found commonly in the “gastric antrum and the duodenum” whereas Stress ulcers are found commonly in “fundic mucosa and can be located anywhere within the stomach and proximal duodenum”.

References

↑ Adapted from Benson H. The Relaxation Response. New York: Morrow, 1975; and Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 37:37-46, 1974.