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Stress responses are potentially harmful, especially if they are severe or extend over a long period of time. When stressors end up leading to stress responses, a number of problems can arise, such as burnout, mental disorders, and physical illnesses. Moreover, stress responses, such as emotional responses like anxiety and worry and cognitive responses like having a poor or hopeless attitude, can even worsen any pain that people may be feeling (99).
Burnout is an increasingly intense pattern of psychological, physiological, and behavioral dysfunction in response to a continuous flow of stressors or chronic stress (110; 142). It is commonly found among employees and professionals who have a high degree of personal investment in work and high performance expectations. In the initial stages, people often have a variety of physiological and behavioral symptoms and lose interest and confidence in their work. The following physiological symptoms may occur:
- Shortness of breath
- Loss of appetite or weight
- Fatigue and exhaustion
The following behavioral symptoms may occur:
- Lack of interest in fellow employees
- Risky behavior
- Mood swings
In the later stages, people often do the following things:
- Abuse alcohol and other drugs
- Smoke excessively
- Drink more caffeinated beverages
- Become more rigid in their thinking
- Lose faith in the abilities of co-workers, management, the organization, and themselves
- Become less productive (117)
Another concept, ego depletion, is very similar to burnout. In fact, it may represent an underlying feature of burnout. The idea behind ego depletion is that acts of volitionmaking choices and decisions, taking responsibility, initiating and inhibiting behavior, and making plans of action and carrying them outdraw on a limited supply of volitional energy that is available inside people. Consequently, if people deplete this resource too much, it is no longer very easy to do what they need to do to handle stress, such as trying to use coping strategies in response to stressors (14).
Mental disorders are the result of a varying combination of sources, one of which being stress. Examples of other sources are as follows:
- Chemical imbalances
- Inherited characteristics
- Early learning experiences
- Brain damage
- Psychological traits
The diathesis-stress model explains how stress contributes to the onset of mental disorders. According to this model, chemical imbalances, inherited characteristics, and early learning experiences can make it more likely for people to get mental disorders but whether they do depends on the stressors they encounter (114).
People sometimes have symptoms of mental disorders, but they usually do not meet the criteria or are not clinically significant, severe enough to necessitate treatment. Before a person can be diagnosed with a mental disorder, his or her problematic thoughts, feelings, and actions must meet the criteria for the mental disorder and must prevent adequate social, occupation, or other forms of functioning (7). Accordingly, answering yes to any of the following questions may suggest clinical significance:
- Is the behavior considered strange within the person's own culture?
- Does the behavior cause personal distress?
- Does the behavior interfere with what the person is trying to accomplish?
- Is the person a danger to self or others?
- Is the person legally responsible for his or her acts? (177)
Stress may play a causal role in a wide variety of mental disorders. Some of the mental disorders in which stress appears to have a causal role are anxiety disorders, mood disorders, and substance-related disorders.
Anxiety disorders are characterized by anxiety, either as the primary symptom or the primary cause of other symptoms (80). The presence or absence of panic attacks or agoraphobia is a critical aspect of several disorders. A panic attack " is a discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, symptoms such as shortness of breath, palpitations, chest pain or discomfort, choking or smothering sensations, and fear of 'going crazy' or losing control are present" (7, p. 393). Agoraphobia "is anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms" (7, p. 393).
Twelve different anxiety disorders can be diagnosed:
- Panic disorder without agoraphobia "is characterized by recurrent unexpected Panic Attacks about which there is persistent concern" (7, p. 393).
- Panic disorder with agoraphobia "is characterized by both recurrent unexpected Panic Attacks and Agoraphobia" (7, p. 393).
- Agoraphobia without history of panic disorder "is characterized by the presence of Agoraphobia and panic-like symptoms without a history of unexpected Panic Attacks" (7, p. 393).
- Specific phobia "is characterized by clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behavior" (7, p. 393).
- Social phobia "is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior" (7, p. 393).
- Obsessive-compulsive disorder "is characterized by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralize anxiety)" (7, p. 393).
- Posttraumatic stress disorder "is characterized by the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma" (7, p. 393).
- Acute stress disorder "is characterized by symptoms similar to those of Posttraumatic Stress Disorder that occur immediately in the aftermath of an extremely traumatic event" (7, p. 393).
- Generalized anxiety disorder "is characterized by at least 6 months of persistent and excessive anxiety and worry" (7, p. 393).
- Anxiety disorder due to a general medical condition "is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a general medical condition" (7, p. 394).
- Substance-induced anxiety disorder "is characterized by prominent symptoms of anxiety that are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure" (7, p. 394).
- Anxiety disorder not otherwise specified is used as a diagnosis when anxiety symptoms do not meet the criteria for other disorders or when there is inadequate or contradictory information about anxiety symptoms (7).
Regarding the causal role of stress in anxiety disorders, stressors appear to have a causal influence (12; 101). The specific way in which stressors lead to the onset of anxiety disorders, however, varies depending on the type of anxiety disorder (55). Additionally, posttraumatic stress disorder can be thought of as a prolonged and severe stress response to a catastrophe or to a chronic intense stressor (177).
Mood disorders involve disturbances in mood that range from depression to mania (80). The number of major depressive episodes, manic episodes, mixed episodes, or hypomanic episodes is a critical aspect of several mood disorders. Major depressive episodes involve "at least 2 weeks of depressed mood accompanied by a characteristic pattern of depressive symptoms" (63, p. 194). Mixed episodes involve "at least 1 week of elevated, euphoric, or irritable mood accompanied by a characteristic pattern of manic symptoms" (63, p. 194). Mixed episodes involve "at least 1 week of a mixture of manic and depressive symptoms" (63, p. 194). Hypomanic episodes involve "at least 4 days of elevated, euphoric, or irritable mood that is less severe than a manic episode" (63, p. 194).
Ten different mood disorders can be diagnosed:
- Major depressive disorder "is characterized by one or more Major Depressive Episodes" (7, p. 317).
- Dysthymic disorder "is characterized by at least 2 years of depressed mood for more days than not, accompanied by additional depressive symptoms that do not meet criteria for a Major Depressive Episode" (7, p. 317).
- Depressive disorder not otherwise specified is used as a diagnosis when the depressive symptoms do not meet the criteria for other disorders or when there is inadequate or contradictory information about the depression symptoms (7).
- Bipolar I disorder "is characterized by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes" (7, p. 317).
- Bipolar II disorder "is characterized by one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode" (7, p. 318).
- Cyclothymic disorder "is characterized by at least 2 years of numerous periods of hypomanic symptoms that do not meet criteria for a Manic Episode and numerous periods of depressive symptoms that do not meet criteria for a Major Depressive Episode" (7, p. 318).
- Bipolar disorder not otherwise specified is used as a diagnosis when the bipolar symptoms do not meet the criteria for other disorders or when there is inadequate or contradictory information about the bipolar symptoms (7).
- Mood disorder due to a general medical condition "is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a general medical condition" (7, p. 318).
- Substance-induced mood disorder "is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a drug of abuse, a mediation, another somatic treatment for depression, or toxin exposure" (7, p. 318).
- Mood disorder not otherwise specified is used as a diagnosis when the mood symptoms do not meet the criteria for other disorders or when there is inadequate or contradictory information about the mood symptoms (7).
Regarding the causal role of stress in mood disorders, negative major life events tend to precede depression (177). In fact, compared to the number of negative major life events experienced by people who are not depressed, people who become depressed experience two to three times as many shortly beforehand (73).
Substance-related disorders are characterized by the use of drugs like alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and act (13). Substance-related disorders fall into two categories: substance use disorders and substance-induced disorders. Substance use disorders are characterized by a problematic pattern of substance use, involving dependence on or abuse of substances. Substance-induced disorders are characterized by reactions to the effect of substances on the central nervous system, involving intoxication, withdrawal, and sets of substance-induced features that resemble other disorders (63, 1995). Regarding the causal role of stress in substance-related disorders, the need to reduce stress may be one of the initial causes of substance abuse (23).
Stress is a health hazard. Stress can lead to a variety of physical illnesses and related health problems. In fact, stress has a negative impact on virtually every organ system in the body:
- Cardiovascular system
- Respiratory system
- Endocrine system
- Gastrointestinal tract
- Male and female reproductive systems
- Immune system (81)
Some physical illnesses, such as peptic ulcers, are caused by physiological responses to stressors. Other physical illnesses, such as asthma and skin rashes, however, can occur in the absence of stress but are aggravated by it. Regarding the changes in body chemistry that accompany physiological responses to stressors, increased levels of glucocorticoids are usually more harmful to a person's health than are increased levels of epinephrine and norepinephrine. Prolonged exposure to high levels of glucocorticoids can lead to the following problems:
- Increased blood pressure
- Damaged muscle tissue
- Inhibitted growth
- Immune system suppression
- Brain damage
- Accelerated aging (31)
In particular, stress appears to be a cause of immune system suppression and cardiovascular diseases and an influence on the course of cancer.
Physiological response to stressors can impair the function of the immune system, which leaves people vulnerable illness-promoting substances like viruses, bacteria, and fungi. When a married person dies, for example, it is often the case that his or her spouse dies soon afterward from an infection (31). Additionally, people who are more stressed are more likely to catch a cold than are people who are less stressed, for example (36; 37).
Cardiovascular diseases typically involve high blood pressure and a high level of cholesterol in the blood. People with cardiovascular diseases are prone to have heart attacks and strokes (31). A certain pattern of psychological responses to stressors, referred to as cynical hostility, is a risk factor for coronary heart disease and heart attacks (153). Cynical hostility is characterized by the following thoughts and feelings:
- Frequent anger
- Distrust of others (154; 176)
Although stress may not cause cancer, it can contribute to it by weakening the body's natural defenses against cancerous cells (86). Furthermore, this influence may be particularly strong for people who have major depression, feel hopeless, and are indifferent toward the pain (38). For example, mastectomy patients who are determined to overcome their breast cancer tend to be more likely to survive than mastectomy patients who feel hopeless and are indifferent toward the pain tend to be (75; 124).
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