Stress (anxiety)

• What is Stress (Anxiety)
• Statistics on Stress (Anxiety)
• Risk Factors for Stress (Anxiety)
• Progression of Stress (Anxiety)
• Symptoms of Stress (Anxiety)
• Clinical Examination of Stress (Anxiety)
• How is Stress (Anxiety) Diagnosed?
• Prognosis of Stress (Anxiety)
• How is Stress (Anxiety) Treated?
• Stress (Anxiety) References

What is Stress (Anxiety)

Stress is defined as an organism’s total response to environmental demands or pressures. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?

Statistics on Stress (Anxiety)

Stress impacts, in some form or another, everyone at some stage in their life, just in varying severity. A 1996 study found that 75% of adults felt abnormaly stressed during their working week. This is a real problem and a real health issue. Stress may be implicated in up to 70% of patient visits to the family doctor.
Stress can affect anyone, including children. Stress occurs in virtually all children at some stage as a response to something threatening or dangerous. Not all stress is bad, as stress can be an important means of getting people motivated and active but too much stress can be detrimental to one’s health. Separation anxiety is the most common cause of stress in young children but academic and social pressures (especially the quest to fit in) also lead to stress in older children.

Risk Factors for Stress (Anxiety)

The causes of stress are multiple and varied but they can be broadly classified into external stressors (such as the loss of a relative, where outside forces act on us) and internal stressors (majority of stress is self-generated thus we have some control over it).
Risk factors for uncontrollable stress:

• Social and financial problems
• Medical illness
• Lack of social support
• Family history

Prolonged stress can cause physiological changes that can result in a physical disorder. The following life stressors have been ranked as the top ten life changes that can lead to psychosomatic disorders:

1. Death of a spouse
2. Divorce
3. Death of a close family member
4. Marital separation
5. Serious personal injury or illness
6. Fired from work
7. Jail term
8. Death of a close friend
9. Pregnancy
10. Business readjustment.

It is important to recognise that particular stresses do not affect people equally. Some patients see stress as a challenge to be overcome, whilst others feel overwhelmed. Thus the response of an individual to stress may be mediated by many factors, including the number of different stressors involved, personality style, cultural background, social circumstances, the symbolic meaning of the stress, past life experiences and the availability of supports.

Children
There are numerous possible causes for stress in children that are divided into internal (arising within) and external (outside factors acting on the child) sources. Examples of external sources include:

• Parents or others pressuring children or setting high expectations.
• Sudden unexpected loss or change- Such as loss of a friend or family member, change of school.
• Social situation where the child feels uncomfortable.
• Arguments or conflicts with friends or family.
• Big changes in the family, eg moving house, getting a divorce, losing a job.

Some internal causes of stress problems include:

• Perfectionist personality.
• Too high self-expectations.
• Difficulties coping with change.
• Shyness or feeling uncomfortable in groups.
• Pessimistic attitude.
• Working too hard/trying too hard.
• Poor time management- particularly important in older children who become stressed about homework and exams.
• Unreasonable beliefs.

Progression of Stress (Anxiety)

Stress usually first affects our inner emotions. Initial symptoms may include these feelings:

• Anxiousness
• Nervousness
• Distraction
• Excessive worry
• Internal pressure

These emotional states then can begin to affect your outward appearance:

• Unusually anxious or nervous
• Distracted
• Self-absorbed
• Irritable

As the stress level increases, or if it is prolonged over a long period of time, the severe emotional or physical effects that follow may become a factor:

• Excessive fatigue
• Depression
• Sometimes even think of hurting yourself or others
• Headache
• Nausea and vomiting
• Diarrhoea
• Chest pain or pressure
• Heart racing
• Dizziness or flushing
• Tremulousness or restlessness
• Hyperventilation or choking sensation

In the vast majority of cases, these symptoms remain relatively minor and don’t last very long. If they become more severe or increase in frequency and severity, seek medical help.

Symptoms of Stress (Anxiety)

Your doctor will take a thorough history to identify possible causes and effects of stress. This will include letting you explain your worries, asking questions about your life and particular stressors, and questions regarding symptoms.
The most common symptoms of stress are:

• Physical: fatigue,headache, insomnia, muscle aches/stiffness (especially neck, shoulders and low back), palpitations (awareness of the heart beating), chest pains, abdominal cramps, nausea, trembling, cold extremities, flushing or sweating and frequent colds.
• Mental: decrease in concentration and memory, indecisiveness, mind racing or going blank, confusion, loss of sense of humor.
• Emotional: anxiety, nervousness, depression, anger, frustration, worry, fear, irritability, impatience, short temper.
• Behavioural: pacing, fidgeting, nervous habits (nail-biting, foot-tapping), increased eating, smoking, drinking, crying, yelling, swearing, blaming and even throwing things or hitting.

Children
Identifying stress in children can be difficult as they may be less likely to verbalise their feelings and concerns and more likely to display behavoural changes. The following are some common symptoms of stress in children that should be looked out for:

• Your child becoming easily upset or angry.
• Tiredness and having problems sleeping.
• In teenagers- Smoking or drinking more than usual.
• Complaints of tense muscles, headaches and backache.
• Evidence of worry, feeling overwhelmed and helpless.
• Poor concentration- May be reflected by a drop in school grades.
• Being “jumpy” and “fidgety.”
• Lots of blaming and complaining.
• Diarrhoea.
• Loss of enthusiasm.
• Anhedonia- meaning loss of interest or pleasure in normally enjoyable activities for your child. e.g. sport, hobbies, friends.
• Less resistance to viruses and infections.
• If possible try to determine what is causing your child to worry- Is it a big test coming up at school, due to family conflict or a fight with a friend? Determining the source of stress can help doctors and patients find ways to overcome it.

Clinical Examination of Stress (Anxiety)

Your doctor will conduct a general physical examination, particularly looking for signs of stress such as:

• Twitching or trembling
• Muscle tension
• Headaches
• Sweating
• Dry mouth
• Difficulty swallowing
• Abdominal pain (may be the only symptom of stress especially in a child)

How is Stress (Anxiety) Diagnosed?

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.
There are no specific investigations to identify whether you are stressed and the doctor will normally rely on information gained from the history to make the diagnosis.

Prognosis of Stress (Anxiety)

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, changing 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.
Ongoing stress can have serious complications such as heart attack, stroke and depression.

How is Stress (Anxiety) Treated?

The most effective solution is to find and address the source of your stress or anxiety. Unfortunately, this is not always possible.
A first step is to take an inventory of what you think might be making you “stress out”:

• What do you worry about most?
• Is something constantly on your mind?
• Is anything in particular making you sad or depressed?

If you can identify the source of your stress, remove yourself from it or address the situation. That may be all that is needed to resolve the situation and your anxiety. Even if you are only able to get away for a few seconds or minutes, the break is important and can help you on the way to a more permanent solution.
Lifestyle is also essential:

• Eat a well-balanced, healthy diet. Don’t overeat.
• Get adequate amounts of sleep.
• Exercise regularly.
• Limit caffeine and alcohol.
• Don’t use nicotine, cocaine, or other recreational drugs.
• Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.
• Take breaks from work. Make sure to balance fun activities with your responsibilities.
• Spend time with people doing activities you enjoy.
• Think positively!

Stress can have serious consequences and chronic stress can cause depression and anxiety. if you have symptoms of stress discussed or have difficulty coping, seek professional medical advice. Your doctor can teach you coping mechanisms, provide counselling and offer medications (such as anti-depressants or blood pressure tablets) to reduce the symptoms of stress.

Children
It is important to ensure children and adolescents do not adopt negative methods of coping with stress such as taking drugs and alcohol, smoking, increasing intake of caffeine drinks and cola, continuing to pressure themselves and setting unrealistically high goals.
Parents can help their children’s stress by teaching them how to manage their time, helping them to relax and encouraging a healthy diet and lifestyle. In particular for school and exams, parents should encourage their children to do their best but try not to make them feel pressured or feel you will be disappointed if they don’t do well. Parents can help children studying by being interested in their work, helping them set up a quiet place to study, working out an appropriate study timetable with suitable breaks and providing a healthy diet.

Useful resource

The MindSpot Clinic is a free telephone and online service for Australian adults troubled by symptoms of anxiety or depression. The service is run by a team of health professionals and provides free Online Screening Assessments, free Treatment Courses and can assist in finding local services that can help. To speak to one of the team call 1800 614 434 between 8am -8pm AEST Monday to Friday and 8am – 6pm AEST on Saturday or visit MindSpot Clinic.

Stress (Anxiety) References

1. Children, Youth and Women’s Health Service, Parenting and Child Health, Stress, 2005. Available [online] from URL: http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=141&id=1951.
2. Herbert J, Fortnightly review: Stress, the brain, and mental illness BMJ 1997;315:530-535.
3. Posen D, Stress Management for Patient and Physician, The Canadian Journal of Continuing Medical Education, 1995.
4. Sadock BJ, Sadock VA. Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry 3rd Edition. Lippincott Williams and Wilkins, Philadelphia USA.
5. Turner J, Raphael B, Stress management and counselling in primary care, MJA 1998.
6. Wein H, Stress and Disease: New Perspectives, NIH Word on Health, 2000.