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Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.

Causes and symptoms


The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism's response to the inevitable changes in its physical or social environment, and that positive, as well as negative, events can generate stress as well as negative occurrences. Stress-related disease, however, results from excessive and prolonged demands on an organism's coping resources. It is now believed that 80-90% of all disease is stress-related.
Recent research indicates that some vulnerability to stress is genetic. Scientists at the University of Wisconsin and King's College London discovered that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to experience depression following a stressful event as people with the long version of the gene. Further research is likely to identify other genes that affect susceptibility to stress.
One cause of stress that has affected large sectors of the general population around the world since 2001 is terrorism. The events of September 11, 2001, the sniper shootings in Virginia and Maryland and the Bali nightclub bombing in 2002, the suicide bombings in the Middle East in 2003, have all been shown to cause short-term symptoms of stress in people who read about them or watch television news reports as well as those who witnessed the actual events. Stress related to terrorist attacks also appears to affect people in countries far from the location of the attack as well as those in the immediate vicinity. It is too soon to tell how stress related to episodes of terrorism will affect human health over long periods of time, but researchers are already beginning to investigate this question. In 2004 the Centers for Disease Control and Prevention (CDC) released a report on the aftereffects of the World Trade Center attacks on rescue and recovery workers and volunteers. The researchers found that over half the 11,700 people who were interviewed met threshold criteria for a mental health evaluation. A longer-term evaluation of these workers is underway.
A new condition that has been identified since 9/11 is childhood traumatic grief, or CTG. CTG refers to an intense stress reaction that may develop in children following the loss of a parent, sibling, or other loved one during a traumatic event. As defined by the National Child Traumatic Stress Network (NCTSN), "Children with childhood traumatic grief experience the cause of [the loved one's] death as horrifying or terrifying, whether the death was sudden and unexpected (for example, due to homicide, suicide, motor vehicle accident, drug overdose, natural disaster, war, terrorism, and so on) or due to natural causes (cancer, heart attack, and so forth). Even if the manner of death does not appear to others to be sudden, shocking, or frightening, children who perceive the death in this way may develop childhood traumatic grief. In this condition, even happy thoughts and memories of the deceased person remind children of the traumatic way in which the deceased died." More information on the identification and treatment of childhood traumatic grief can be obtained from the NCTSN web site, 〈〉.


The symptoms of stress can be either physical or psychological. Stress-related physical illnesses, such as irritable bowel syndrome, heart attacks, arthritis, and chronic headaches, result from long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness results from inadequate or inappropriate responses to major changes in one's life situation, such as marriage, completing one's education, becoming a parent, losing a job, or retirement. Psychiatrists sometimes use the term adjustment disorder to describe this type of illness. In the workplace, stress-related illness often takes the form of burnout—a loss of interest in or ability to perform one's job due to long-term high stress levels. For example, palliative care nurses are at high risk of burnout due to their inability to prevent their patients from dying or even to relieve their physical suffering in some circumstances.


When the doctor suspects that a patient's illness is connected to stress, he or she will take a careful history that includes stressors in the patient's life (family or employment problems, other illnesses, etc.). Many physicians will evaluate the patient's personality as well, in order to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that doctors can use to help diagnose the amount of stress that the patient experiences and the coping strategies that he or she uses to deal with them. A variation on this theme is to identify what the patient perceives as threatening as well as stressful. Stress-related illness can be diagnosed by primary care doctors, as well as by those who specialize in psychiatry. The doctor will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g., thyroid activity) that have psychological side effects.


Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of mainstream approaches to stress-related illness. Present treatment regimens may include one or more of the following:
  • Medications. These may include drugs to control blood pressure or other physical symptoms of stress, as well as drugs that affect the patient's mood (tranquilizers or antidepressants).
  • Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient's life. They often focus on job or workplace-related stress.
  • Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical exercise programs including walking.
  • Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs.
  • Cognitive therapy. These approaches teach patients to reframe or mentally reinterpret the stressors in their lives in order to modify the body's physical reactions.
  • Meditation and associated spiritual or religious practices. Recent studies have found positive correlations between these practices and stress hardiness.

Alternative treatment

Treatment of stress is one area in which the boundaries between traditional and alternative therapies have changed in recent years, in part because some forms of physical exercise (yoga, tai chi, aikido) that were once associated with the counterculture have become widely accepted as useful parts of mainstream stress reduction programs. Other alternative therapies for stress that are occasionally recommended by mainstream medicine include aromatherapy, dance therapy, biofeedback, nutrition-based treatments (including dietary guidelines and nutritional supplements), acupuncture, homeopathy, and herbal medicine.


The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person's life, many of which are genetically determined (race, sex, illnesses that run in families) or beyond the individual's control (economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress and, thus, change their experiences of it. A person's ability to remain healthy in stressful situations is sometimes referred to as stress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life's changes as positive opportunities rather than as threats.


Complete prevention of stress is neither possible nor desirable, because stress is an important stimulus of human growth and creativity, as well as an inevitable part of life. In addition, specific strategies for stress prevention vary widely from person to person, depending on the nature and number of the stressors in an individual's life, and the amount of control he or she has over these factors. In general, however, a combination of attitudinal and behavioral changes works well for most patients. The best form of prevention appears to be parental modeling of healthy attitudes and behaviors within the family.



Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I, "Spirituality and Healing." New York: Simon & Schuster, 2002.


Blumenthal, J. A., M. Babyak, J. Wei, et al. "Usefulness of Psychosocial Treatment of Mental Stress-Induced Myocardial Ischemia in Men." American Journal of Cardiology 89 (January 15, 2002): 164-168.
Cardenas, J., K. Williams, J. P. Wilson, et al. "PSTD, Major Depressive Symptoms, and Substance Abuse Following September 11, 2001, in a Midwestern University Population" International Journal of Emergency Mental Health 5 (Winter 2003): 15-28.
Centers for Disease Control and Prevention. "Mental Health Status of World Trade Center Rescue and Recovery Workers and Volunteers—New York City, July 2002–August 2004." Morbidity and Mortality Weekly Report 53 (September 10, 2004): 812-815.
Gallo, L. C., and K. A. Matthews. "Understanding the Association Between Socioeconomic Status and Physical Health: Do Negative Emotions Play a Role?" Psychological Bulletin 129 (January 2003): 10-51.
Goodman, R. F., A. V. Morgan, S. Juriga, and E. J. Brown. "Letting the Story Unfold: A Case Study of Client-Centered Therapy for Childhood Traumatic Grief." Harvard Review of Psychiatry 12 (July-August 2004): 199-212.
Hawkley, L. C., and J. T. Cacioppo. "Loneliness and Pathways to Disease." Brain, Behavior, and Immunity 17, Supplement 1 (February 2003): S98-S105.
Latkin, C. A., and A. D. Curry. "Stressful Neighborhoods and Depression: A Prospective Study of the Impact of Neighborhood Disorder." Journal of Health and Social Behavior 44 (March 2003): 34-44.
Ottenstein, R. J. "Coping with Threats of Terrorism: A Protocol for Group Intervention." International Journal of Emergency Mental Health 5 (Winter 2003): 39-42.
Ritchie, L. J. "Threat: A Concept Analysis for a New Era." Nursing Forum 39 (July-September 2004): 13-22.
Surwit, R. S., M. A. van Tilburg, N. Zucker, et al. "Stress Management Improves Long-Term Glycemic Control in Type 2 Diabetes." Diabetes Care 25 (January 2002): 30-34.
West, P., and H. Sweeting. "Fifteen, Female and Stressed: Changing Patterns of Psychological Distress Over Time." Journal of Child Psychology and Psychiatry 44 (March 2003): 399-411.
White, K., L. Wilkes, K. Cooper, and M. Barbato. "The Impact of Unrelieved Patient Suffering on Palliative Care Nurses." International Journal of Palliative Nursing 10 (September 2004): 438-444.


The American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703 (914) 963-1200. Fax: (914) 965-6267.
National Child Traumatic Stress Initiative. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Parklawn Building, Room 17C-26, Rockville, MD 20857. (301) 443-2940.


National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs. Fact Sheet: Survivors of Human-Caused and Natural Disasters.
National Institute of Mental Health (NIMH) news release, July 17, 2003. "Gene More Than Doubles Risk of Depression Following Life Stresses." 〈〉.


1. forcibly exerted influence; pressure.
2. in dentistry, the pressure of the upper teeth against the lower.
3. a state of physiological or psychological strain caused by adverse stimuli, physical, mental, or emotional, internal or external, that tend to disturb the functioning of an organism and which the organism naturally desires to avoid. stress reactions are elicited but should these reactions be inappropriate or inadequate, they may lead to disease states. The term is also used to refer to the stimuli that elicit such a state or stress reactions. Just as a bridge is structurally capable of adjusting to certain physical stresses, the human body and mind are normally able to adapt to the stresses of new situations. However, this ability has definite limits beyond which continued stress may cause a breakdown, although this limit varies from person to person.

Physical Stress. There are many kinds of physical stress, but they can be divided into two principal types, to which the body reacts in different ways. There is emergency stress, a situation that poses an immediate threat, such as a near accident in an automobile, a wound, or an injury. There is also continuing stress, such as that caused by changes in the body during puberty, pregnancy, menopause, acute and chronic diseases, and continuing exposure to excessive noise, vibration, fumes, chemicals, or other agents.

The body's reaction to emergency stress is set off by the adrenal medulla. The medulla of each adrenal gland is directly connected to the nervous system. When an emergency arises, it pours the hormone epinephrine into the bloodstream. This has the effect of speeding up the heart and raising the blood pressure, emptying sugar supplies swiftly into the blood, and dilating the blood vessels in the muscles to give them immediate use of this energy. At the same time, the pupils of the eyes dilate. (See also alarm reaction.)

The reaction of the body to continuing stress is even more complex. Again the principal organs are the adrenal glands, but after the first phase of alarm, the glands continue to produce a steady supply of hormones that apparently increase the body's resistance. This is in addition to specific defenses such as the production of antibodies to fight infection. If the stress is overwhelming, as in the case of an extensive third-degree burn or an uncontrollable infectious disease, the third phase, exhaustion of the adrenal glands, sets in, sometimes with fatal results.
Psychologic Stress. The emergency response of the body comes into play when a person merely foresees or imagines danger, as well as in real emergency situations. The thought of danger, or the vicarious experience of it in a thrilling story, play, or film, may be enough to cause the muscles to tense and the heart to start pounding. Psychologic situations can have the same effect. One of the best-known examples of this is “stage fright,” often characterized by tensed muscles and an increased heart rate. At times the person may not even be aware of the unconscious thought that produces this dramatic reaction.
Stress and Disease. In recent decades, there have been numerous attempts to find a direct correlation between certain diseases and a stressful environment or a personality type that responds to the environment in a certain way. However, while inappropriate activity and a hectic lifestyle can cause illness in some persons, a busy and productive person can actually be subject to less stress than one who feels trapped in a limited position with no hope for release or a sense of accomplishment.

The diseases most often associated with a stressful environment are, according to some scientists, coronary artery disease and “heart attack,” high blood pressure, and cancer. Studies of laboratory animals have demonstrated a connection between isolated and specific stimuli such as electric shock and separation from mates and the development of heart disease in these animals. The stressful variables in the human environment are, however, much more complex, and a stressful environment can be related to heart disease only as a risk factor (see type a behavior).

The postulated relationship between stress and the development of a malignancy is based on the theory that destructive emotions affect and in some way weaken the body's surveillance system, causing its immune response to fail to recognize and destroy malignant cells.

Although relaxation techniques can reduce blood pressure in persons with mild hypertension, there is no evidence that tension and stress cause the blood pressure to rise and stay at levels above normal.

Other diseases considered by some researchers to be related to stress include asthma, allergies, colitis, migraine headaches, and peptic ulcers. Even though the relationship is not clear and there are currently no hard data to support this, most health care providers are convinced that stress contributes to the worsening of symptoms and influences the impact a disease will have on the lives of some patients while other patients adapt to stress and seem to have no long-term deleterious reaction to it.
Coping Mechanisms. Unhealthy ways to cope with psychologic stress include drug abuse and alcoholism, smoking, abusive and violent behavior, and working harder to accomplish unrealistic or poorly defined goals. In order to deal with stress in an effective and healthy way, one must first identify sources of stress, either within oneself or in one's environment.

Job stressors are frequently related to disorganization in the work place, poor time management, and unrealistic or uncommunicated expectations of the employer. Another source of stress for the working person may be the lack of time for family and recreation because of job demands. Once job stressors are identified, some options are to change the stressful situation, modify the way one responds to stressors, or seek another job that is less stressful. In some instances learning to be more assertive and better able to communicate with supervisors and coworkers can reduce job-related stress.

Stressors in the home environment include negative self-concept; inadequate physical, cognitive, or behavioral resources; poor problem-solving skills; marital discord; ineffective parenting or lack of parenting skills; and lack of family support. Effective coping may require strategies to improve self-concept and build self-esteem, develop problem-solving skills, learn effective parenting, and establish a network of people who can give support. Exercise, improving one's nutritional status, making time for recreational activities, and utilizing relaxation techniques to relieve tension can also be healthy ways to cope with stress.
oxidative stress any of various pathological changes seen in living organisms in response to excessive levels of cytotoxic oxidants and free radicals in the environment.
stress reaction any of the biological reactions to adverse stimuli, physical, mental, or emotional, internal or external, that tend to disturb the organism's equilibrium; should these compensating reactions, physiological or psychological, be inadequate or inappropriate, they may lead to disorders. See alarm reaction, acute stress reaction, general adaptation syndrome, acute stress disorder, adjustment disorder, and posttraumatic stress disorder.


1. Reactions of the body to forces of a deleterious nature, infections, and various abnormal states that tend to disturb its normal physiologic equilibrium (homeostasis).
2. In dentistry, the forces set up in teeth, their supporting structures, and structures restoring or replacing teeth as a result of the force of mastication.
3. The force or pressure applied or exerted between portions of a body or bodies, generally expressed in pounds per square inch.
4. In rheology, the force in a material transmitted per unit area to adjacent layers.
5. In psychiatry and psychology, the abnormal mental and emotional state in response to a physical or physiologic stressor.
6. Stressor, in the sense that psychological stress can be a stressor to a person physically and the physical stress of illness can also be a psychological stressor.
7. In endocrinology, state of threatened homeostasis in which stressors are the threatening forces and adaptive responses are the forces of the organism that reestablish homeostasis.
[L. strictus, tight, fr. stringo, to draw together]


1. forcibly exerted influence; pressure.
2. force per unit area.
3. in dentistry, the pressure of the upper teeth against the lower in mastication.
4. a state of physiological or psychological strain caused by adverse stimuli, physical, mental, or emotional, internal or external, that tend to disturb the functioning of an organism and which the organism naturally desires to avoid; see also stress reaction, under reaction.
5. the stimuli that elicit such a state or stress reactions.


2. A condition of metabolic or physiologic impairment in an organism, occurring usually in response to adverse events and capable of causing physical damage.
3. A condition of psychological strain occurring usually in response to adverse events and capable of causing symptoms and signs such as increased blood pressure, insomnia, and irritability.


Etymology: OFr, estrecier, to tighten
any emotional, physical, social, economic, or other factor that requires a response or change. Examples include dehydration, which can cause an increase in body temperature, and a separation from parents, which can cause a young child to cry. Stress can be positive or negative. Ongoing chronic stress can result in physical illness. Stress has been theorized as a major contributing factor in many physical diseases, such as asthma. Stress may also be applied therapeutically to promote change, such as implosive therapy for phobic patients, in which the patient is given support while being exposed to the situation that produces anxiety and is thereby gradually desensitized. The nature and degree of stress observed in a patient are frequently evaluated by the nurse as part of the ongoing holistic nursing assessment. See also general adaptation syndrome.


A force that causes a change in physical or mental health. See Biotic stress, Oxidative stress, Physical stress, Stressor Psychology A noxious physical or mental stimulus that may cause a loss of self-control Clinical Depression, over/undereating, too tired for sex, anger, crying, physical Sx fatigue, headache, backache, insomnia, anxiety, palpitations, ↑ colds/flu, nervous stomach, skin complaints; feeling of disorganization, loss of concentration. See Chronic stress, Job stress, Mental stress, Physician stress, Shear stress, Social stress, Workplace stress.


Cardiology A clinical trial–Stent Restenosis Study comparing outcomes of coronary stent placement to balloon angioplasty in treating CAD. See Balloon angioplasty, Coronary angioplasty, Coronary artery disease, Stenting.


2. dentistry The forces set up in teeth, their supporting structures, and structures restoring or replacing teeth as a result of the force of mastication.
4. rheology The force in a material transmitted per unit area to adjacent layers.
5. psychology A physical or psychological stimulus such as very high heat, public criticism, or another noxious agent or experience that, when impinging on a person, produces psychological strain or disequilibrium.


Any physical, social or psychological factor or combination of factors that acts on the individual so as to threaten his or her well-being and produce a physiological, often defensive, response. The response to stress may be beneficial, distressing or, occasionally, dangerous. Responses such as the production of ADRENALINE and CORTICOSTEROIDS, raised heart rate and blood pressure, increased muscle tension and raised blood sugar, are natural; but persistent civilized suppression of the natural physical concomitants (fight or flight) may be damaging. Most medical scientists view with scepticism the proposition that many human diseases are caused by stress. There is, however, no questioning the fact that overwhelming stress can cause physical and psychological damage. See POST-TRAUMATIC STRESS DISORDER.


(1) in mechanics, the force per unit area applied to a body or object. Measured in newtons per square metre (N.m-2) or pascals (Pa); (2) the psychological and/or physiological response of an organism to any demand made upon it by agents threatening its physical or emotional well-being. stressor any factor that causes a stress response. stress management any of a range of methods used to reduce or manage the negative effects of stress, such as relaxation techniques and biofeedback. See also anxiety.


resisting force (within a body) to potentially deforming forces/loads incident upon that body; and distributed throughout the material sustaining the load; the greater the amount of the material subject to load, the lower the overall stress to the material


body reaction to external and internal events upsetting homeostasis and ability to deal with external events; instrumental in disease onset/manifestation, e.g. ischaemic heart disease, rheumatoid arthritis and psoriasis


n any factor (environmental, chemical, physical, or emotional) that contributes to the “stress response” (physiologic reactions to tension). Has been implicated in a number of diseases—including asthma, autoimmune disease, cancer, cardiovascular disease, diabetes, depression, irritable bowel syndrome, premenstrual tension syndrome, rheumatoid arthritis, and ulcers.


An instrument for examining substances in polarized light. It consists of a polarizer and an analyser with their planes of polarization at right angles to each other. In the regions where the material is stressed (such as an ophthalmic lens tightly mounted in a metal frame) it becomes birefringent and the observer sees a system of dark fringes in that region. When used to detect strain in glass or plastic it is called a strain tester. Safety glass (except the chemically strengthened type) displays a characteristic strain pattern when viewed in a polariscope. See safety glass; strain.


1. In dentistry, forces set up in teeth, their supporting structures, and structures restoring or replacing teeth due to force of mastication.
2. Reactions of body to forces of a deleterious nature, infections, and various abnormal states that tend to disturb its normal physiologic equilibrium (homeostasis).


n 1. a force induced by or resisting an external force; measured in terms of force per unit area.
2. the force of energy directed against a tissue structure or against the function of tissue as the result of injury and trauma associated with fracture, burn, infection, surgical procedure, pharmacologic action, or anxiety states. The response to stress involves local metabolic function, the hormonal activity of the endocrine system regulated by the pituitary gland, and the autonomic and central nervous systems. The stress phenomenon is often associated with the general adaptation syndrome.
3. in prosthetic dentistry, forcibly exerted pressure (e.g., the pressure of the maxillary teeth against the mandibular teeth or the pressure contact of a distorted removable partial denture on the supporting teeth or ridge structures).
stress, axial,
n excessive force applied vertically to the teeth and their periodontium.
stress, bone in,
n the responses of bony structures to applied force. With application of excessive pressure stimuli to bone, adaptation may occur by the formation of thicker and more numerous trabeculae. If tissue components cannot compensate for excessive stress, bone resorption will occur.
stress, buccolingual,
n an excessive pressure exerted against teeth and their attachment apparatus from a buccal or lingual aspect.
stress, compressive,
n the internal induced force that opposes shortening of the material in a direction parallel to the direction of the stress.
stress control,
stress, damage to restorations by,
n a mechanical property that pertains to the capacity of substances used for restorative and preventive applications to loosen in response to continual pressure over time. See also strain.
stress response,
n the physiologic changes that occur as a result of threatening situations, including rapid breathing, increased heart rate, and increased perspiration. Also known as the “fight or flight” response.
stress, shearing,
n the internal induced force that opposes the sliding of one plane of the material on the adjacent plane in a direction parallel to the stress.
stress, tensile,
n the internal induced force that opposes elongation of a material in a direction parallel to the direction of stress.
stress-bearing area,


1. forcibly exerted influence; pressure, e.g. compression, tension.
2. the sum of the biological reactions to any adverse stimulus, physical, mental, or emotional, internal or external, that tends to disturb the homeostasis of an organism. Should these reactions be inappropriate, they may lead to disease states. The term is also used to refer to the stimuli that elicit the reactions, e.g. heat, nutritional, lactational, confinement, transportation. See also psychosomatic disease.

stress induced diarrhea of the horse
see acute undifferentiated and chronic undifferentiated diarrhea of the horse.
porcine stress syndrome
see porcine stress syndrome.
stress reaction
stress-starvation syndrome
said of sheep. See pregnancy toxemia.
stress testing
a test for evaluating circulatory response to physical stress produced by exercise. See also exercise testing.

Patient discussion about stress

Q. How to not be stressed from my job? I have a very stressful job. I stay up all night thinking about my assignments for the next day. During work hours I barely eat and my boss yells at me all the time. What to do? This is affecting my family life since I take all my stress out on them?

A. If you like where you’re working but your job is too stressful, ask if the company can tailor the job to your skills or move you to a less pressured slot. If that doesn't help and the level of stress at your job is harming your health and your relationships, and you don’t see any prospect of real change, it may be time to move on.

Q. How to deal with stress before exams? I am a college student and get very stressed out before tests. Are there good methods to relieve stress?

A. Have you tried aromatherapy? the scents of the essential oils can activate the limbic system of your brain, helping to relieve stress and increase alertness before your exams.

This articles recommends a good custom blend of essential oils when using Aromatherapy for Stress:

Q. Can stress really affect your health?? I’ve been having a stressed period at work in the past three months. I heard a lot of times:” don’t stress up-it’ll kill you eventually..” but is it physically true?

A. defenitely true, it's been proven that stress might cause gastrointestinal desorders.

More discussions about stress