Psychology in Health and Social Care

Stress and Illness

Introduction

According to Ayers and De Visser (2018), there is a complex relationship between stress and illness. Several causes of stress have been studied and range from life events such as death and divorce to minor irritations such as being stuck in traffic or losing something (Ayers, & De Visser, 2018; Oerlemans et al., 2007). Such causes of stimuli are known as stressors. Any situation or event that is mentally or physically straining can be perceived as a stressor as it interferes with the normal working of the body. Though stress has been linked to various psychological and physical illnesses, it is worth noting that short-term stress is good for human health as it can boost one’s immune system (Aldwin, 2007). However, long-term stress lowers resistance to illnesses and this has a significant impact on the individual’s vulnerability to psychological and physical disorders. Though everyone is susceptible to stress, the vulnerability to it varies between individuals and different factors influence such vulnerability and how people respond to stress under different situations (Antoni et al., 2001). In this paper, the researcher defines the term stress and critically evaluates evidence of how stress affects illness by assessing stress responses among individuals under different situations (Blumenthal et al., 2005, p.13). The relationship between stress and physical health is also evaluated to identify factors that make people susceptible to stress. The paper concludes by evaluating the physiological consequences of stress. 

Evaluation of Stress and Stress Responses

Stress is a process in which environmental demands strain the adaptive capacity of an individual leading to both biological and psychological changes that could expose them to the risk of illness. No one is immune to stress irrespective of their social status and age. However, it is worth noting that not all kinds of stress harm the human body. There are three main types of stress including eustress, acute stress, and chronic stress (Bower & Segerstrom, 2004, p.10). Eustress is usually exciting and is positive stress that helps individuals to remain energised. It is associated with surging levels of adrenaline such as when one is racing, skiing or under pressure to meet certain deadlines. Acute stress, on the other hand, is short-term stress and is either positive or negative (Everly & Lating, 2019). It is the most common type of stress encountered by people in their daily lives (Cohen & Williamson, 1991, p.12). Finally, chronic stress is the prolonged and inevitable such as the stress of an abusive marriage or a severely strenuous job. According to Llewellyn et al. (2019), the sustenance of life is critically based on maintaining the body’s internal setting in the face of changing surroundings. The maintenance of such a balance is referred to as homeostasis. Therefore, stress could be viewed as anything that adversely threatens homeostasis.

Theoretical Perspectives of Stress Response and Illness

Stress-response theory is the primary model that explains how stress response affects health. The theory was proposed by Selye who identified the various elements of stress response pattern including thymicolymphatic, atrophy, cortex hypotrophy, and gastrointestinal ulcers (Selye, 1956). The three elements are closely interdependent and often accompany most illnesses as they are the most provoked regardless of the kind of illness or stimulus. According to Selye (1956), stress is the most common denominator of all adaptive responses in the body. Moreover, the theorist defined stress as a condition manifested by a particular syndrome consisting of all non-specifically stimulated fluctuations in the biological system (Morey et al., 2015, p.15). Such fluctuations could be measured and occurred at both the system and local level. Moreover, Selye proposed the term local adaptation syndrome (LAS) to refer to the whole stress process at the local level including the risk and individual’s response (Everly & Lating, 2019). At the system level, an individual’s response to stress is referred to as general adaptation process (GAS) (Selye, 1956). Both LAS and GAS are viewed as closely coordinated body responses where the latter acts as a backup as described below.

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GAS is the underlying reason why stress is a primary cause of health challenges. Since stress changes the normal functioning of the body, it interrupts the natural balance of homeostasis which is crucial for the body health (Graham, Douglas, & Ryan, 1986, p.395).  Moreover, stress is a major factor that lowers body resistance and triggers several processes involved in disease development. The GAS comprises three theoretical steps including alarm, resistance, and exhaustion stage (Morey et al., 2015, p.15). During the alarm stage, the autonomous nervous system is stimulated which is characterised with decreased muscle toning, hypothermia, and hypotension. The alarm stage lasts up to 24 hours based on the stressor’s intensity and individual’s vulnerability (Selye, 1956). If the stressor persists, a counter-shock phase arises which is characterised with a flight-or-fight response. The counter-shock phase is also characterised with increased respiration, increased blood pumping into vital organs, and increased alertness (Morey et al., 2015, p.17). Symptomatically, such body reactions make individuals experience a racing heart, palpitations, headache, palpitations or dysphagia.

For the body to survive the alarm phase, it must adapt some resistance. The resistance phase is characterised by a drastic reduction in the alarm response (Selye, 1956). During the resistance stage, the body develops an adaptation strategy which is characterised by higher functioning levels (Carver & Scheier, 1989, p.274). Such an adaptation involves multiplication, enlargement, or readjustment of cell elements or tissues to perform different function (Selye, 1956). The adjustments may be viewed as survival attempts of the body’s catatoxic and syntoxic defense strategies to promote coexistence of the body functions and stressor.

The exhaustion phase follows the resistance stage when the body fails to maintain the normal levels of functioning. During the exhaustion stage, there is increased endocrine activity and increased circulation of cortisol which leads to negative impacts on the various body physiological functions including the immune, digestive and the circulatory systems (Selye, 1956). At this stage, human resources get depleted and this result in the permanent destruction of body systems via tear and wear, and illness may ultimately occur.

Physical Responses to Stress and Variations between Individuals and Situations

It is worth noting that vulnerability and response to stress vary among individuals. In particular, individual risk factors that lead to the onset of anxiety or depression following a stressful occasion include previous psychiatric history, gender, neuroticism, and other socio-demographic factors (Pow et al., 2017). Moreover, Oerlemans et al. (2007) suggested the presence of evidence for bidirectional relationships between environmental adversity and personality. Most specifically, an individual’s degree of emotionality, neuroticism, and reactivity are correlated with event proneness and interpersonal relationships (Cobb & Steptoe, 1996, p.407). Also, an individual’s physical response to stress is determined by protective factors such as self-esteem, social support, optimism, and coping abilities (Lutgendorf, Sood, & Antoni, 2010). For instance, people with social support can cope better with acute stressors compared to those without such support (Cohen et al., 1983, p.389). Some common physical responses of stress among individuals include high breathing rates, increased irritability, headaches, and dry mouth.  

Moreover, stressful events or situations have to interact with different background factors to result in illness. The main factors influencing an individual’s vulnerability to stress include social support, coping style, personality type, and genetic vulnerability (Pow et al., 2017, p.71). When an individual is subjected to a demanding condition or a problem, the first response is to assess its severity and determine if there are adequate resources to cope with it. If such an assessment shows that the resources available are inadequate, then an individual is said to be under stress. Therefore, the physical response to different situation employed by individuals makes them susceptible to illness (Mund, 2016, p.35). Moreover, the specific characteristics of a situation are related to the extent of the stress response. Such characteristics include the severity or intensity of the stressors and the controllability of such stressors alongside other features that determine the type of cognitive responses or assessments.  

According to Friedman and Rosenman’s 1974 research that investigated the correlation between an individual’s personality and coronary heart disease, it was found that men with Type A personality were more prone to develop the disease compared to those with type B personality (Kozela et al., 2016). Individuals with Type A personality are believed to have a high level of control over their personal or work pressure. It is this high control that makes the majority of them to be high achievers. They mostly perceive life changes as challenges as opposed to stressors. Moreover, Mund (2016) investigated how various personalities handled stress in relation to a physical response. From this study, the researcher showed that possessing a hardy personality could be the most protective response against stress-related disorders. For example, the study found individuals with no protective factors to be the most exposed to stress-related illnesses compared to those who exhibited a resilient personality (Morey et al., 2015, p.14). Protective factors included the presence of social support and engagement of physical activities. 

Relationship between Stress and Illness

A considerable amount of research has also been carried out in the past to identify the relationship between stress and physical health. For instance, Kozela et al. (2016) investigated the relationship between workplace stress and illness using a sample of 7372 civil servants working in London in which symptoms of heart diseases were measured. From the study, the researchers found employees in high-grade jobs which had more responsibilities to be at an increased risk of developing cardiac disorders than those in low-grade jobs. Therefore, this finding suggests that cardiac illnesses could be triggered by workplace-related stress that comes with increased job grade and responsibilities. 

Moreover, another research investigated the relationship between an individual’s behavioral response and stress. The study found out that low socioeconomic status could make individuals prone to stress and ultimately vulnerable to unhealthy lifestyles including poor diet, alcoholism, and smoking (Conway, Hammen, & Brennan, 2012). As a result, this could exposure such individuals to the risk of cardiovascular disorders. 

In particular, Chang et al. (2018) established that stress is a major contributor to the commencement and progression of both mental and physical illnesses. Physical illness is related to stress due to the biological response system of the body. Some human and animal-based studies have established that irrepressible stressors lead to increased gastric lesion tendencies thereby reducing immune resistances.

Morey et al. (2015) carried out several studies to support the theory that long-term stress suppressed the immune system. The authors also found that cortisol caused the liver to excrete fatty acids and glucose into the bloodstream when the body is under chronic stress. Alongside increased blood pressure and heart rate, the excess fatty acids and glucose in the blood could contribute to the blockage of blood vessels thus increasing an individual’s risk of developing cardiac diseases (Biggs, Brough, & Drummond, 2017, p.354).

The relationship between stress and physical health can also be understood when examining the impact of stress on an individual’s life. In particular, stresses related to finances, relationships and living conditions could result in physical health illnesses (Chang et al., 2018, p.56). Moreover, the impact of stress is likely to be severe if the stressed individual has chronic diseases such as diabetes (Ayers, & De Visser, 2018). During periods of high-stress levels, the body response is based on the type of stress. For instance, acute stress such as being involved in an accident could cause a verbal breakdown, and trigger arrhythmias, heart attack or sudden death. Nevertheless, such scenarios often affect people with heart disorders (Llewellyn et al. 2019). Moreover, chronic stress can severely impact on an individual’s health. More specifically, chronic stress causes the autonomous nervous system to be overactive and this may cause damage to body tissues. The initial symptoms of chronic stress include mild headaches which prolong overtime and increased vulnerability to colds (Antoni et al., 2001). Increased exposure to chronic stress has also been linked to complicated health problems including pain, headaches and migraines, depression, obesity, hyperthyroidism, ulcers, heart disorders, hair loss, and diabetes (Blumenthal et al., 2005, p.15). The following section provides a brief overview of how stress is associated with some of these health complications.

First, research has established that chronic stress could cause the imbalance of various brain chemicals including norepinephrine, dopamine, and serotonin (Sherin & Nemeroff, 2011). Moreover, stress can elevate the cortisol level in the brain which ultimately causes a chemical imbalance (Bower & Segerstrom, 2004, p.10). Such chemical imbalances affect an individual’s sex drive, appetite, sleep pattern, and mood. 

Second, stress is also known to be a common cause of headaches, including migraine. For instance, research has found that relaxation following a stressful moment could contribute to acute migraine headache (Cohen & Williamson, 1991, p.13). Such a headache could be attributed to the let-down effect which can be managed via behavioral adjustment or medication. 

Moreover, life stress is associated with the onset and deterioration of mast cell-related illnesses such as allergies and asthma. More specifically, histamine is secreted by the mast cells in the body and causes allergic symptoms which are associated with stress (Lillberg et al., 2014, p.196). Moreover, prolonged stress levels can lead to allergic reactions. Examples of allergies include skin rashes, watery eyes, and runny nose. Stress has also the potential to cause an asthma attack, asthmatic people. 

Stress also plays a critical role in obesity progression. Research has shown that high cortisol levels caused by chronic stress could affect various factors that lead to weight gain such as poor sleep which increases cortisol levels further, ultimately leading to increased belly fats (Lutgendorf et al., 2011, p.254). Moreover, stress contributes to poor nutrition which increases an individual’s cravings for refined and sweet carbohydrates. Obese people are exposed to several illnesses such as cancer and diabetes. 

Furthermore, Chryssanthopoulou et al. (2005) suggested that all categories of stress such as financial stress, major life occurrences, and emotional stress, expose individuals to increased risk of heart disorders. More specifically, stress increases cholesterol and blood pressure all of which are directly related to heart disorders (Lutgendorf, Sood, & Antoni, 2010). Finally, the authors argue that stress could considerably increase the risk of death from a heart disorders. 

Psychological Consequences of Stress

Psychological stress refers to the situation in which environmental demands exceed the adaptive capability of the body thereby leading to biological and psychological changes that may expose an individual to the risk of illnesses. Stress is usually preceded by anxiety disorders. Research has shown that anxiety occurs before the onset of depression (Sherin & Nemeroff, 2011, p.265). More specifically, individuals with anxiety are more likely to develop depression following an occurrence of stressful life incident. Exposure to stressful events is high among the general population where estimates range between 40% and 70% (Lutgendorf, Sood, & Antoni, 2010). Some of the psychological consequences of stress include post-traumatic stress disorder (PTSD) and acute stress disorders (ASD). These illnesses exhibit common features attributed to stressful events. 

People with ASD face difficulties of staying or falling asleep and intrusive thoughts. ASD has a shorter timeframe and lasts between two days to one month. PTSD, on the other hand, affects people shortly after exposure to traumatic events such as disasters (Pow et al., 2017, p.71). Moreover, stress has also been found to contribute to eating disorders, sleep challenges, and substance abuse. People living in high-stress environments such as communities with high natural disasters and divorce rates indulge in smoking and drug abuse more which leads to high mortality rate as a result of illnesses like chronic obstructive pulmonary disorder and cancer (Kozela et al., 2016). A longitudinal study conducted by Conway, Hammen, and Brennan (2012) found that people smoked more cigarettes during high-stress days. 

Stress is also associated with a suppressed immune system which increases the chances of altering the course of a disease. In particular, stress has been linked to emotional disorders. When stress increases beyond coping levels, it may result in numerous psychological problems (Oerlemans et al., 2007). In particular, stress triggers the secretion of hormone which causes the stimulation of the immune system and enables the body to react to short illnesses or injuries. Chronic exposure to stress could lead to overstimulation of the immune system and this could lead to its weakening. Consequently, the immune system is rendered incapable of adequately averting disease or infection from developing (Sherin & Nemeroff, 2011, p.268). Therefore, highly stressed people are susceptible to illnesses and infections and deterioration of existing disorders. 

Psychological consequences of stress can also be assessed by analysing how stress impacts on self-reporting strategies such as Cohen’s 1983 perceived stress scale. Cohen’s stress scale is used to date by psychologists in measuring an individual’s perception of stress (Cohen & Williamson, 1991, p.15). The scale is based on subjective interpretations which are important in capturing an individual’s perception of stress and their coping ability. 

According to Biggs, Brough, and Drummond (2017), an individual’s psychological perception of an event determines the extent to which they find it stressful. The psychological appraisal of stress could be categorised into two phases including primary and secondary appraisal (Gerst et al., 1987, p.530). In primary appraisal, individuals assess the extent to which a stressful situation is important while the coping capability is evaluated during the second phase. Chang et al. (2018) analyzed the effect of stress on an individual’s appraisal coping ability in a stressful situation. The study established that people with higher scores on primary appraisals were those who used more coping techniques. Moreover, the study found people with a high score on secondary appraisals to possess less physical stress symptoms and showed increased life satisfaction. The findings of this study support the theory that individuals who perceive a challenge or an event as an opportunity as opposed to stress have a higher capacity to cope with life situations and suffer less from psychological impacts of such stress. Finally, people who perceive a situation to be greater than their coping ability end up depressed (Preussner, HellhammerDirk, & Kirschbaum, 1999, p.199). However, psychological therapies can be used to treat such individuals (Morey et al., 2015, p.16). Psychological therapies focus on changing the thinking or the way an individual perceives problems and this helps in changing their coping ability. 

Conclusion

It can be deduced that stress indeed exposes individuals to illnesses. Nevertheless, several factors, both physical and psychological, impact on the extent to which stress contributes to illness. For instance, an individual’s perception of a stressor and their coping ability play a critical role in the onset and progression of an illness. Moreover, this study has found that stress affects how individuals behave and this could lead to the onset and progression of illnesses. For instance, having a resilient personality and presence of good social support could lessen the likelihood of developing stress-related illness among individuals. Therefore, physical and psychological influences play a critical role in the onset and progression of stress-related illnesses. 

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