CHRONIC STRESS: SYMPTOMS, CAUSES, TREATMENTS - DUDAS - 2025

The chronic stress is a type of adjustment disorder characterized by an unhealthy emotional and behavioral reaction to an identifiable and prolonged stress situation. It differs from anxiety in that in this the stressful stimulus is not identifiable.

Stress is an adaptive response of our body to an excessive demand from the environment or to a situation with a high emotional charge. Stressful situations can be both negative and positive, for example they can cause us the same stress to show up for an important exam and get married.

This ability allows us to prepare ourselves to respond to stressful stimuli. To do this, you first need to become aware of the situation. If we identify the stimulus as stressful, the neuroendocrine system will be activated and a neurophysiological response will be emitted, characterized by a rise in activation levels.

When intermediate stress levels are reached, our performance in the face of the stressful situation will be optimal, but if the stressful situation continues to occur for a long time, our neuroendocrine system is exhausted, the stress is no longer adaptive and chronic stress appears (see Figure one).

The levels of stress necessary to reach the optimum level and to reach chronic stress depend on many variables (context, personality, type of stimulus); therefore it varies from person to person.

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

Characteristics of chronic stress

The emotional and behavioral reaction to chronic stress must occur within 3 months after the stressful situation has occurred and must be of great intensity.

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

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

To speak of chronic stress, the above symptoms must persist for more than 6 months. It is important to clarify that these symptoms should not respond to a grieving reaction, since in that case it would be a normal response, not a maladaptive one.

Symptoms of chronic stress

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

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

Course and prognosis

Most symptoms diminish and often disappear as time passes and stressors are eliminated, without the need for any type of treatment.

However, when stress becomes chronic it is more difficult for this to occur, since it can facilitate the appearance of other disorders such as depression or anxiety, or even promote the use of psychoactive substances.

Who can suffer from chronic stress?

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

Chronic stress can be suffered at any age, although it is especially common in children and adolescents, and affects women and men indifferently.

Chronic stress cases occur throughout the world, but the way these cases manifest themselves and the way they are studied varies greatly depending on the culture.

In addition, cases of chronic stress are more numerous in disadvantaged cultures or in developing countries. Likewise, they tend to be more frequent in populations with low socioeconomic levels.

Risk or protective factors

There are many factors or variables that can increase or decrease the probability of having an adjustment disorder, although there is no known variable that by itself determines the appearance of this disorder.

The variables can be:

Individual

The individual variables that can influence the appearance of an adjustment disorder are those that influence the way in which the person perceives and copes (coping) with stressful situations. These variables include:

• Genetic determinants. Certain genotypes can make the individual 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.

Social

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

• The family: it can be a strong protective barrier against stress, if there is a good family relationship, but it can also be stressful if it is an unstructured family or with particularly authoritarian educational styles. It must be borne in mind that it is not convenient either to share all the stress with the family since this can destroy the family unit.
• The peer group: friends (or partners) in adolescence and the partner in adulthood are very influential factors during our lives. As with the family, they can be both risk and protective factors. But, unlike what happened with the family, we can choose the people around us, therefore it is important to recognize when they are constituting risk factors and eliminate them from our lives if necessary.

Treatment

The design of the treatment will depend on multiple factors, among which it is worth highlighting:

• The age of the person.
• Your general condition and medical history.
• The specific symptoms you suffer from.
• If you have any subtype of the disorder.
• The tolerance or susceptibility of the person to certain medications or therapies.

It is recommended to use multimodal holistic treatments that include the important areas of the patient's life, for example, psychotherapy, family therapy, behavior modification, cognitive restructuring and group therapy could be combined.

All treatments pursue the same objectives:

1. Relieve symptoms that are already occurring, for which relaxation techniques can be very helpful.
2. Teach the person and offer him support to handle the current stressful situation, and the possible future situations as well as possible.
3. Reinforce and, if necessary, restructure the social environment. For this, new ties must be created and existing ones strengthened, starting with forming a healthy psychologist-patient relationship.
4. Identify the individual factors that may favor or hinder the development of the disorder and adherence to treatment.
5. Follow maintenance to assess the progression of the patient.

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

Psychotherapeutic treatment

There are very diverse treatments but we will focus on cognitive-behavioral therapy and systemic therapy as they are the most used.

Cognitive behavioral therapy

This approach is aimed at teaching the patient to develop their own tools to solve problems, 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 wide variety of techniques, such as biofeedback, problem solving, cognitive restructuring, relaxation techniques, among others.

Systemic therapy

Of the systemic therapies the most common are:

• Family therapy. This therapy is aimed at modifying the necessary aspects in the family to make it a protective factor. For this, knowledge of the patient's problem, communication and interaction between family members and mutual support are promoted.
• Group therapy. This type of therapy is usually done when the patient is getting better. It can be very useful but care must be taken, since it can make the patient not identify his responsibility for the problem and therefore not work to recover because he believes that he does not depend on himself.

Psychopharmacological treatment

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

It is important to take the drug only when the doctor prescribes it and in the doses indicated by it, 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 psychoactive drug (or in the wrong dose) and may even cause other disorders.

In the case of chronic stress, anxiolytics or antidepressants are usually pre-registered 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 (for example amphetamines) can also be pre-registered.

References

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