Chronic stress is a situation where persistent stressors repeatedly trigger the flight-or-fight response leading to the prolonged elevation of stress hormones, especially cortisol and epinephrine in the blood stream. These hormones, when not used in a real emergency wear down the body’s systems. For example, cortisol can cause the body to digest it’s own proteins, lead to decreased immunity, sleep disturbances, and an increase of substance P (related to the sensation of pain). When a threat has passed, epinephrine that has not been reabsorbed produces a shaky, nauseous, pumped up after-feeling. In situations of chronic stress, epinephrine causes over-stimulation of the autonomic nervous system and adrenal exhaustion associated with fatigue and mental weariness. These hormones are linked to conditions like high blood pressure, gastric ulcers, suppression of the immune system, and mood or personality changes.

It is possible that wherever the body is weakest, perhaps from an old injury or because of genetic predisposition, shows wear and dysfunction from chronic stress first. A body under constant stress becomes more susceptible to infections and disease. People adapt quickly to challenging situations and may not recognize that symptoms such as insomnia, chronic tension headaches or heartburn are related to stress. Massage therapists often deal with habitual tension patterns in muscles. “Bracing” physically against non-physical, and in fact psychological threats, may very well be at the root of a good deal of physical tension. One researcher speculates that in the case of cancer, the body would normally eliminate a mutant cell, but if the system is dysfunctional because of hormonal imbalance due to stress, the cell may take hold and develop into a tumor.¹⁷²

Stressors

The term “stressor” was coined by Hans Selye, a researcher who first defined stress, and refers to any stimulus that produces stress. Stressors are unique to individuals and increase or decrease in strength based on the surrounding situation. A stressor for one person may not produce stress in another. If you perceive something as a threat (whether real or imagined) and it produces the emotions of anxiety, fear, anger, or grief it is considered a stressor. Something that you perceive as stressful today may not cause you stress tomorrow because stressors are influenced by factors such as your mental-emotional state of mind, your physical health, the culture you grew up in, your past experiences, coping strategies, and even what you had for lunch (did you have a double latte loaded with caffeine for example?). Researchers note that stressors can often be defined as too much or too little of certain types of external stimuli. For example, extreme heat, cold, loud music, bright lights, too much exposure to social situations or technology can be stressors. Alternately too much quiet, and lack of social interaction could be stressors.¹⁷³

Stressor Scale

Psychiatrists Thomas Holmes and Richard Rahe developed a scale for rating stressors in 1967. The pair examined the medical records of approximately 7,000 patients to determine if stressful life events could cause illness.¹⁷⁴ The patients were asked to tally a list of life events based on a scoring system and a strong correlation was found between these events and their illnesses. In the Holmes and Rahe Stress Scale a specific number of “Life Change Units” are associated with each life event (Table 4-1). An adapted scale was created latter to better assess the stress levels of young adults or non-adults with different life experiences (Table 4-2).  In the original scale the death of a spouse is extremely stressful and allotted 100 life change units, while the minor violation of a law is far less stressful and allotted 11 life change units. To take the assessment, people mark the life events that they have experienced in the last year and tabulate the associated life change units. A score of 300 or more indicates high stress and a high risk of illness. A score of 150-299 indicates moderate stress and a moderate risk of illness (reduced by 30% from the high rating), and a score of 149 or lower indicates lower stress and a low risk of illness. You can tabulate your personal stress score for this year by filling in the right hand column in either the original scale or the adapted scale for younger adults and non-adults and adding up the life change units. <tab4-1><tab4-2>

Stress Related Illnesses

If you review the glands and organs affected by the autonomic nervous system, it makes sense that stress affects every body system on some level. For example:

• Integumentary system: Skin disorders like psoriasis and atopic dermatitis are worsened by stress. Some forms of hair loss are linked to stress. Neuro-dermitis is a skin disorder that causes severe itching of the skin and is likely caused by an overactive sympathetic nervous system and the subsequent imbalance in the endocrine system related to stress.
• Musculoskeletal system: Muscle tension is increased when the body is under stress and this may lead to chronic tension patterns, and postural imbalances. Conditions like temporal mandibular joint disorder (TMJ) may be caused or worsened by stress.
• Nervous system: Anxiety is a normal response to stress, but if stress is prolonged a number of disorders can develop such as panic disorder, post-traumatic stress disorder, and social anxiety disorder. Stress also plays a role in depression and mood disorders.
• Digestive system: Brief bouts of stress (i.e., a presentation at work) may cause short digestive system reactions such as a stomachache, nausea, or diarrhea. Gastritis, stomach and duodenal ulcers, colitis and irritable bowel syndrome are closely associated with chronic stress.
• Urinary system: While urinary retention (problems emptying the bladder) has many possible causes, one of them is stress. Stress can also worsen conditions including interstitial cystitis (painful bladder syndrome) where the bladder wall becomes irritated and inflamed.
• Reproductive system: CRH released during the flight-or-fight response inhibits the release of gonadotrophin releasing hormone (GnRH). GnRH is the hormone that directs reproduction and sexual behavior. Cortisol inhibits the release of luteinizing hormone, which stimulates ovulation and sperm release, and hinders the production of male and female sex hormones like testosterone, estrogen, and progesterone. Stress levels influence infertility, menstrual disorders, and sexual disorders.
• Endocrine system: As we discussed earlier stress can cause imbalances in powerful hormones that help regulate many body functions. The adrenal glands can go through three different phases as they attempt to deal with chronic stress. In the first stage (adrenal adaptation) the adrenals increase the production of stress hormones resulting in digestive issues, jitteriness, weight gain, menstrual problems, and sleep disturbances. In the second stage (adrenal maladaption) the adrenal glands slow down resulting in fatigue, loss of sexual drive, fluid retention, and hair loss. The third stage (adrenal exhaustion) is associated with conditions like fibromyalgia, severe constipation, depression, memory loss, joint pain, and panic attacks. Thyroid disorders are also closely linked to stress.
• Cardiovascular system: Research indicates that stress contributes to sustained elevation of blood pressure as well as triggering or aggravating cardiovascular pathologies like coronary heart disease, angina, and ischemic cardiopathy, among others.
• Lymphatic and immune system: Stress makes people more susceptible to catching common illness and can impair the body’s inflammatory response. Conditions involving excessive inflammation, like allergic, autoimmune, cardiovascular, infectious, and rheumatologic illnesses are exacerbated by stress. People experiencing chronic stress recover more slowly from a wide variety of diseases and conditions.
• Respiratory system: Asthma symptoms worsen under increased levels of stress.

Dr. Barbara Brown notes in Stress and the Art of Biofeedback, that the disease that occurs, and which internal process is involved, is the consequence of a very complex interaction of psychological, constitutional, genetic, and environmental factors. The pattern is unique to each person.¹⁷⁵ As Selye noted, the body is capable of adaptation, and a return to homeostasis if the stressor is removed or lessened. For instance, once the alarm stage has passed the adrenal glands return to their normal rates of secreting hormones. If the stressor continues to be active, adaptation and resistance lead to a stage of exhaustion and the body becomes highly vulnerable to disease and accelerated aging. Table 4-3 lists some symptoms associated with stress while Box 4-3 lists some common conditions related to or exacerbated by stress. <tab4-3> <box4-3>