Chronic stress is a type of adjustment disorder characterized by an unhealthy emotional and behavioral reaction to an identifiable and prolonged stressful situation (in this differs from anxiety because in it the stress or 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. To do this, one must first become aware of the situation. If we identify the stimulus as a stressor, the neuroendocrine system will be activated and a neurophysiological response will be emitted, characterized by an increase in arousal levels (we alert ourselves, our pulse accelerates and our muscles tighten, raise our defenses to protect ourselves against possible infections, etc.).
When we reach intermediate levels of stress, our performance against the stressful situation will be optimal, but if the stressful situation continues to occur, our neuroendocrine system is depleted, stress ceases to be adaptive and chronic stress appears (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,) therefore varies from person to person.
Figure 1. Yerkes-Dodson curve. Too low or too high levels of stress cause a decrease in productivity while intermediate levels of stress cause high productivity.
Chronic Stress Symptoms
The emotional and behavioral reaction to chronic stress should occur within less than 3 months after the stressful situation and must be very intense (more disabling than might be expected, such as crying before an examination).
This disorder includes the following symptoms (according to DSM-V):
- A greater discomfort than expected in response to the stressful stimulus.
- A significant deterioration of social and work (or academic) activity.
To talk about chronic stress, the above symptoms should persist for more than 6 months. It is important to clarify that these symptoms should not respond to a mourning reaction since in that case it would be a normal, non-maladaptive response.
There are subtypes, in which the symptomatology of this and other disorders is combined:
- Adaptive disorder with depression: this type includes symptoms such as depressive mood , crying and hopelessness.
- Anxiety adaptation disorder: such as nervousness, worry or restlessness or, in the case of children, fear of separation of important people in their lives (usually parents).
- Adaptive disorder with anxiety and depressive state: this type combines the symptoms of the two previous ones.
- 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, property, quarrel, ??).
- Disorder of adaptation with disturbance of emotions and behavior: here the symptomatology of all previous 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 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 occur at any age, although they are especially prevalent in children and adolescents, and it affects women and men indifferently.
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 countries in routes of development. It is also more frequent in populations with low socioeconomic levels.
Risk factors or protection
There are many factors or variables that can increase or decrease the likelihood of an adaptation disorder, although there is no known variable that by itself determines the onset of this disorder.
The variables can be:
The individual variables that may 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.
- 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.
The social environment is very important as both a risk factor and protector, as 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 against stress, if there is a good family relationship, but it can also be stressful if it is a family with no structure 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 constitute risk factors and eliminate them from our life if necessary, health comes first.
The design of the treatment will depend on multiple 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 medications 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 treatments pursue the same objectives as:
- Relieve the symptoms that are already occurring, for which relaxation techniques can be very useful.
- Teach the person and provide support to manage the current stressful situation, and possible future situations, the best possible.
- 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.
- Identify individual factors that may favor or hinder the development of the disorder and adherence to treatment.
- Follow maintenance to evaluate the progression of the patient.
As for the nature of the treatment, psychological or psychopharmacological, it is recommended to start with psychotherapy and begin with psychotropic drugs only if necessary, but always continuing with psychotherapy.
There are many different treatments but we will focus on cognitive-behavioral therapy and systemic therapy as the most used.
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 coping strategies.
This approach includes a variety of techniques such as biofeedback, problem solving , cognitive restructuring , relaxation techniques, ??
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 this they promote the knowledge of the problem of the patient, the communication and interaction between the members of the family and the mutual support.
- Group Therapy. This type of therapy is usually done 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.
Chronic Stress 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 should 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 the 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, anxiolytics or antidepressants are usually prescribed depending on the patient’s symptoms. Only if the anxiety is very intense can the taking of antipsychotics at low doses be indicated. In specific cases where there is significant inhibition or isolation, psychostimulants (eg amphetamines) may also be pre-registered.