Chronic Stress: Symptoms, Causes, Treatments

He Chronic stress Is a type of adjustment disorder that is characterized by an unhealthy emotional and behavioral reaction to an identifiable and prolonged stress situation (in this it differs from anxiety Because in this the stressful stimulus is not identifiable).

Stress is an adaptive response of our body to an excessive demand of the environment or a situation with a high emotional load. Stressful situations can be both negative and positive, for example, it can cause us the same stress to introduce ourselves to an important examination and get married.

This ability allows us to prepare to respond to stressful stimuli. This requires first taking awareness of the situation. If we identify the stimulus as stressful, the Neuroendocrine system And a Neurophysiological response, Characterized by a rise in arousal levels (we become alert, accelerate our pulse and strain our muscles, raise our defenses to protect us against possible infections, etc.).

When intermediate levels of stress are reached, our performance against the stressful situation will be optimal, but if the stressful situation continues to be produced on a long-term basis Neuroendocrine system Is depleted, the stress ceases to be adaptive and the Chronic stress (See Figure 1).

The levels of stress needed to reach the optimal level and to reach chronic stress depend on many variables (context, personality, type of stimulus,??) thus varies from person to person.

Figure 1. Yerkes-Dodson curve. Too low or too high levels of stress lead to a decrease in productivity while intermediate levels of stress cause high productivity.

Characteristics of chronic stress

The emotional and behavioral reaction of chronic stress should occur within less than 3 months after the stressful situation and should be very intense (more disabling than might be expected, for example, crying before an examination).

This disorder includes the following symptoms (according to DSM-V):

• A discomfort greater than expected in response to the stressful stimulus.
• A significant deterioration of social and work (or academic) activity.

To talk about stress chronic The above symptoms should persist for more than 6 months. It is important to clarify that these symptoms should not respond to a reaction of duel Since in that case it would be a normal response, not maladaptive.

There are subtypes, in which the symptomatology of this and other disorders is combined:

• Adjustment disorder with depression: This type includes symptoms such as Depressive mood , Crying and hopelessness.
• Anxiety adaptation disorder: Symptoms such as nervousness, worry or restlessness or, in the case of children, fear of separation of important people in their lives (usually parents) would be included here.
• Adjustment disorder with anxiety and depressive state: In this type the symptomatology of the two previous ones is combined.
• Adjustment disorder with behavioral disturbance: People who suffer from this disorder conduct behaviors that involve the violation of the rights of others and the violation of social norms and rules (for example, abstaining from school, destroying property, fighting).
• Adjustment disorder with disturbance of emotions and behavior: Here the symptomatology of all the above types is combined.

Symptomatology of chronic stress

People who suffer from chronic stress may suffer from the following symptoms:

• Depressed mood, sadness.
• Difficulty breathing.
• Chest pain.
• Anxiety or worry.
• Feeling of inability to deal with problems.
• Difficulty performing their daily routines.
• Feeling of inability to plan ahead.

Course and forecast

Most of the symptoms diminish and often disappear as time passes and stressors disappear, without the need for any kind of treatment, but when stress is chronic it is more difficult to occur because it can facilitate the onset of other disorders Such as depression or anxiety or even promote psychoactive substance use.

Who can suffer from chronic stress?

It has been estimated that between 5-20% of the population that has been assisted by psychological problems suffer an adaptation disorder (within which chronic stress is included). In children and adolescents, this percentage increases to 25-60%.

Chronic stress can be any age, Although they are especially frequent in children and adolescents, and it affects indifferently to women and men .

There are cases of chronic stress in all cultures But the way in which these cases are manifested and the way of studying them varies considerably depending on the culture, in addition the cases of chronic stress are more numerous in disadvantaged cultures or in developing countries. It is also more frequent in populations with Socioeconomic levels low.

Risk factors or protection

There are many factors or variables that can increase or decrease the likelihood of an adaptation disorder, although no variable is known that in itself determines the onset of this disorder.

The variables can be:

Individuals

The individual variables that can influence the occurrence of an adaptation disorder are those that influence the way in which the person perceives and coping with stressful situations. These variables include:

• Genetic determinants . Certain genotypes may cause the individual to have a greater predisposition or vulnerability to stressful situations.
• Social skills . People with better social skills will be able to seek the necessary support in their environment.
• The intelligence . Smarter people will develop more effective strategies to cope with the stressful situation.
• Cognitive flexibility . Flexible individuals will adapt better to situations and will not perceive them as stressful.

Social

The social environment is very important both as a risk factor and as a protector, since it can be an additional tool to cope with stress, but it can also lead to the appearance of certain stressors (divorce, Mistreatment , bullying ,??). The main social variables are:

• The family Can be a strong protective barrier to stress if there is a good family relationship, but it can also be stressful if it is a broken family or with particularly authoritarian educational styles. Keep in mind that it is not convenient to share all the stress with the family as this can disrupt the family nucleus.
• The peer group . Friends (or partners) in adolescence and the couple in adulthood are very influential factors during our life. As with the family, they can be both risk and protective factors. But, unlike what happened with the family, people around us can choose them, so it is important to recognize when they are constituting risk factors and eliminate them from our life if necessary, health comes first.

Treatment

The design of the treatment will depend on many factors, including:

• The age of the person.
• Your general condition and medical history.
• The specific symptoms you have.
• If you have any subtype of the disorder.
• The tolerance Or susceptibility of the person to Certain medicines Or therapies.

Although there are several treatments, it is recommended to use multimodal holistic treatments that include important areas of life of the patient, for example could combine psychotherapy, family therapy, behavior modification, cognitive restructuring and group therapy.

All the treatments pursue the same objectives that are:

1. Relieve the symptoms that are already occurring, for which Relaxation techniques Can be very useful.
2. Teach the person and provide support to manage the current stressful situation, and possible future situations, the best possible.
3. Reinforce and, if necessary, restructure the social environment. To do this, new bonds must be created and existing ones reinforced, starting with a healthy psychologist-patient relationship.
4. Identify individual factors that may favor or hinder the development of the disorder and adherence to treatment.
5. Follow a maintenance to evaluate the progression of the patient.

As for the nature of treatment, psychological or psychopharmacological, it is recommended to start with psychotherapy and start with psychotropic drugs only if necessary, but always continuing with psychotherapy.

Psychotherapeutic treatment

There are many different treatments but we will focus on the Cognitive-behavioral therapy And systemic for being the most used.

Cognitive-behavioral therapy

This approach is aimed at teaching the patient to develop their own problem-solving tools, to improve communication and to manage impulses, anger and stress.

The intervention focuses on modifying thoughts and behaviors in order to improve adaptation strategies.

This approach includes a variety of techniques such as Biofeedback , Solving problems , the Cognitive restructuring , Relaxation techniques,??

Systemic therapy

Of the systemic therapies the most usual are:

• Family therapy . This therapy is oriented to the modification of the necessary aspects in the family to make it a protective factor for it, they promote the knowledge of the patient's problem, the communication and interaction between the members of the family and the mutual support.
• Group Therapy . This type of therapy is usually performed when the patient is improving. It can be very useful but care must be taken because it can cause the patient not to identify his responsibility in the problem and therefore does not work to recover because he believes that he does not depend on himself.

Psychopharmacological treatment

Psychotropic drugs are only indicated in cases particularly resistant to psychotherapy and in severe cases (such as subtypes of adaptation disorder with anxiety or depression), but Must always be accompanied by psychotherapy.

It is important to take the drug only when the doctor prescribes it and in the doses that it indicates to us since the choice of the psychoactive drug to take depends on multiple factors, for example not all Antidepressants Have the same effects, and it can be very dangerous to take the wrong psychotropic drug (or in the wrong dose) and may even cause other disorders.

In the case of chronic stress, it is usually pre-written Anxiolytics or Antidepressants Depending on the symptomatology of the patient. Only if the anxiety is very intense can the Antipsychotics At low doses. In specific cases where there is significant inhibition or isolation, you can also pre-register Psychostimulants (For example amphetamines).

Recommended material p To know more

• Buendía, J. (Coord.) (1993). Stress and Psychopathology . Madrid: Pyramid.
• Lazarus, R.S. And Folkman, S (1986). Stress and Cognitive Processes . Barcelona: Martínez Roca.
• Sapolsky, R. (1995) Why do not zebras have an ulcer? The Guide to Stress. Madrid: Alianza Editorial.

Interesting books

• Sobolewicz, T. (2002). I have survived hell. STATE MUSEUM OF AUSCHWITZ-BIRKENAU.

Interesting Films

• Landis, J. (1985). When the night comes (Into the Night). United States: Universal Pictures.
• Leigh, M. (2002). All or Nothing (All or Nothing). United Kingdom: Co-production GB-France; Thin Man Films / Les Films Alain Sarde / StudioCanal.
• Tavernier, B. (1999). Today begins all (Ça commence aujourd'hui). France: Les Films Alain Sarde / Little Bear / TF1 Films Production.

References

1. Batlle Vila, S. (2007-2009). Adaptive Disorders. Master in Paidopsiquiatría . Barcelona: Universitat Autònoma de Barcelona.
2. Carlson, Neil (2013). Physiology of Behavior. Pearson. Pp. 602-606. ISBN 9780205239399 .
3. González de Rivera and Revuelta, J. (2000). ADAPTIVE AND STRESS DISORDERS. Virtual Congress of Psychiatry. Retrieved on March 2, 2016, from psychiatry.com.
4. Holmes, T., & Rahe, R. (1967). The social readjustment rating scale. J. Psychoson. Beef. , 213-218.
5. MedlinePlus. (October 3, 2014). Medical Encyclopedia. Obtained from Adaptive Disorder.
6. Perales, A., Rivera, F., & Valdivia, Ó. (1998). Adaptive disorders. In H. Rotondo, Manual of psychiatry. Lima: UNMSM. Retrieved from sisbib.unmsm.edu.pe.
7. Psychomed. (S.f.). DSM-IV. Obtained from Adaptive Disorders psicomed.net.
8. Rodríguez Testal, J. F., & Benítez Hernández, M. M. (s.f.). Adaptive Disorders. Clinical Psychopathology . Seville: University of Seville.