HansSelye was an endocrinologist who did pioneering work in stress..he defined general adaptation syndrome and types of stress.
Stress is used as an umbrella term to cover the body reactions, both physiological and psychological, to any event to which a human being has to adapt.
These events are called stress. That means any event or circumstance which tend to disrupt the homeostasis of body i.e normal equilibrium of body.
Stressors basically trigger stress response in body.They can be internal or external stressors.
Not every life event or circumstance causes stress response. It depends upon appraisal by the individual. When a demand is placed on us there occurs primary appraisal that is evaluation of the significance of event. Then occurs secondary appraisal in which we evaluate coping resources.
If we feel that firstly we are in trouble and secondly there are no coping resources we are likely to experience stress response.
Walter canon found out that stress causes outpouring of stress hormones in the body. Whenever we perceive an immediate threat our sympathetic nervous system and endocrine systems become activated.
The sympathetic nervous system increases the heart rate, respiration, diverts energy from digestion, causes redistribution of glucose and lipids.
In modern society we seldom face by acute stress..when the stressors are present for long time 3stages occur.. Alarm stage is similar to flight and fight mechanism. Body then copes up with stress but at a higher physical cost.. Levels of stress hormones may be raised in blood.. Continuing stress then causes depletion of stress hormones..at exhaustion stage. Psychosomatic illnesses set in
Prior to 20th century, the principal threats to health were contagious diseases caused by infectious agents. Unfortunately as we conquered these diseases chronic diseases such as heart diseases, cancer etc are conditionally rising. The traditional view of physical illness as purely biological phenomenon has been replaced by biopsychosocial model involving interaction between biological, psychological and sociocultural factors.
People suffering from HIV infection progress faster to AIDS if they are exposed to stress. Various auto immune diseases like eczema, rheumatoid arthritis develop in people suffering from chronic stress. Incidence of common cold, diarrhea also increases in people suffering from stress.
Freidman and Rosenmam followed 3000 healthy men aged 35-59years for 9 yrs. At the end of 9 yrs 257 of the men had suffered from heart attacks. Out of which 69% of heart attacks were suffered by people having type A personalities. Also none of the pure type B type men had suffered from heart attack.
WHO world health day theme 2013 is high blood pressure. One of three adults suffer from hypertension.
PTSD although recognized from post vietnam war in world.. In india emphasis on it was place after icmr conducted study on victims of latur earthquake..these people were found to have fear psychosis still thinking about other disaster hitting them.
These changes can be detected by the individual or family members, collegues and friends.. This can form one of the steps in primary prevention of various non communicable diseases, depression and suicides.
A number of decisions we make about ourselves have far reaching consequences. Eg: choosing wrong habits, unwise financial investments which can result in endless list of stressors. For this 1st we have to identify the problem at hand. Identify the alternative ..decide best option. Commit to the decided course of action.Physical exercises increases the levels of endorphins in body which help to increase serotonin levels acting as antidepressent.
Dr. Gulrukh Hashmi
Stress is the spice of life….who
would enjoy a life of no runs, no
hits and no errors?
-Hans Selye, M.D.
Types of stressors
Types of stress
Body response to stress
Stress and illness
Post traumatic stress disorders
Scales to measure stress
Stress is the process by
which we perceive and
respond to certain
events that we see as
Any event or circumstance that causes stress is called
Stressor as such does not cause stress but our
perception of that event, the meaning we attach to it and
the way we react to it leads to symptoms or diseases of
Acute stress is the reaction to an immediate threat,
commonly known as the fight or flight response. The threat
can be any situation that is experienced, even
subconsciously or falsely, as a danger.
Common acute stressors include:
Frequently, however, modern life poses on-going stressful
situations that are not short-lived and the urge to act (to fight
or to flee) must be suppressed. Stress, then, becomes chronic.
Common chronic stressors include:
• on-going highly pressured work,
• long-term relationship problems,
• loneliness, and
• persistent financial worries.
It is the “good” kind of stress
Something pleasing will result at the
end of the stressful situation
• Planning a wedding
• Planning a party
• Completing your last semester before
It is a displeasing kind of stress
It is the “bad” kind of stress
It causes the most harm to the body
Death of a loved one
Natural disasters like earthquakes, floods
Stress resides neither in the person alone nor in the
situation alone, but rather in a transaction between
Subjective (cognitive) interpretation of stressful
events or life changes
Walter Cannon (1932)
When an organism
perceives threat systems of the body get activated.
Seyle’s general adaptation syndrome
There are 3 stages:
1. Alarm stage :- occurs when person recognizes threat
and mobilizes resources.
2. Resistance :- occurs when the stress is prolonged
3. Exhaustion :- occurs when body‟s resources are
Stress and illnesses
PSYCHOSOMATIC DISEASES are defined as
physical ailments with a genuine organic basis that are
caused in part by psychological factors, especially
emotional distress… hypertension, ulcers, asthma, eczema,
and migraine headaches
EMOTIONAL PROBLEMS like anger, panic, fatigue,
sleep disorders, depression, suicide/attempted suicides.
Stress weakens the immune system by diverting the
energy required for its functioning to deal with the
Cortisol, a hormone released during stressful situations,
affects the immune system greatly by preventing the
production of cytokines.
During chronic stress, cortisol is over produced, causing
fewer receptors to be produced on immune cells so
that inflammation cannot be ended.
Stress and immunity
Clogging of the vessels that nourish the heart
Chronic stress causes
- increase in the levels of lipids
- blood to become stickier (possibly in preparation
of potential injury), increasing the likelihood of an
artery-clogging blood clot.
Stress and chronic heart diseases
Types of personalities
Essential Hypertension is a condition in which there
is chronic high blood pressure, usually with no
known biological cause.
. An individual that shows an exaggerated cardiac
response to a variety of stimuli is more likely to
Stress and hypertension
Stress and diabetes mellitus
increase in blood
sugar level to help
This may be
The hormones released during stress response
can alter the numbers and types of immune
cells, such as T-cells and natural killer (NK)
cells produced by the body and also increase
Since immunity and inflammation affect
cancer, stress is extrapolated to affect
cancer on this basis.
Stress and cancer
There is intense constriction of blood
vessels supplying to brain.
This is followed by distension to allow blood to
flow back to the brain.
These distended blood vessel pushes on the nerve
Stress and headaches
• Asthma: Chronic inflammatory disease of the airways
in the lungs, in which the airways become constricted,
making it difficult to empty the lungs and therefore
reducing the amount of air that can be inhaled.
• Psychological factors
Negative family environment
Stress and asthma
It has been suggested that there occurs disturbance
in gut-brain axis.
The large intestine becomes irritated, and its
muscular contractions are spastic rather than
smooth and wave like. The abdomen is bloated and
the patient experiences cramping and alternating
periods of constipation and diarrhea.
Stress and irritable bowel syndrome
Chronic Fatigue Syndrome
Menstrual cycle disorders
Other stress related disorders
Social problems like
1. Drug and alcohol use
3. Broken/ problem families
4. Accidental injuries
Immunological diseases like rheumatoid arthritis
Divorced or widowed individuals
Risk factors for stress
Work-related stress is the response people may have
when presented with work demands and pressures
that are not matched to their knowledge and abilities
and which challenge their ability to cope
Competition and rivalries
Excessive work , long hours of work or night
Drab and monotonous jobs, job insecurity.
Lack of opportunities for advancement
Unpleasant physical conditions at work.
Apart from health related problems there can
Irresponsibility and violence
Effects of occupational stress
It is a disorder that follows exposure to a life
threatening or other extreme event that caused
feelings of horror or helplessness.
Sexual assault, rape,
robbery, aggravated assault
Survivors of disasters
Post traumatic stress disorder
• Impaired concentration
• Emotional numbing
• Symptoms can last for years
1. Daily hassles scale: for minor but frequent stress
2. Social readjustment rating scales: it measures the
impact of various life events
3. Face to face interviews.
4. Life experience surveys
Life Events Score
Death of spouse 100
Marital separation from mate 65
Detention in jail, other institution 63
Death of a close family member 63
Major personal injury or illness 53
Fired from work 47
Marital reconciliation 45
Major change in the health or
behavior of a family member 44
Sexual difficulties 39
Gaining a new family member 39
(e.g., through birth, adoption, oldster
Major business re-adjustment 39
(e.g., merger, reorganization,
Major change in financial status 38
Death of close friend 37
Change to different line of work 36
Major change in the number of
arguments with spouse 35
Taking out a mortgage or loan
for a major purchase 31
Foreclosure on a mortgage or loan30
Major change in responsibilities at
Less than 150 life change units = 30% chance of
developing a stress-related illness
150 - 299 life change units = 50% chance of illness
Over 300 life change units = 80% chance of illness
Richard Lazarus and his colleagues have suggested
that the petty annoyances, frustrations, and
unpleasant surprises we experience every day
reduce psychological well being.
These may add up to more grief
worsening already present illnesses.
Daily hassles scale
It is important to recognize early signs of stress.
If these signs are present all the efforts should be
directed towards strengthening the coping
Early signs of stress
Learn decision making techniques
Developing time management skills
Progressive muscular relaxation
Yoga and meditation
Family acts as the first support system for an
Children model their parent‟s behaviours, including
those related to managing stress.
Having regular conversations can help
a family work together to better
understanding and address any stress.
Focus has been more on work related stress.
Sakhi/saheli programme under Rajiv Gandhi
scheme for empowerment of adolescent girls.
Stress management programme in colleges.
1. WHO AFMC’s Textbook of Public health and
community medicine .
2. T Bhaskar Rao „s Textbook of Community
3. Dr. B Sridhar Rao Principles of Community
4. WHO India work related stress.
6. Rajiv Gandhi Scheme for empowerment of
Adolescent (Sabla) Handbook.
6. Frans pouwer, nina kupper, marcel C adriaanse. Does
emotional stress causes diabetes mellitus type
2?review from the European depression in diabetes
research consortium.published on feb 11,2010
7. Mc Ewen. BSProtection and damage from acute and
chronic stress: allostasis and allostatic overload and
relevance to the pathophysiology of psychiatric