Physiological or biological STRESS is an organism's response to a stressor such as an environmental condition. Stress is the body's method of reacting to a challenge. Stimuli that alter an organism's environment are responded to by multiple systems in the body. The autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis are two major systems that respond to stress. The sympathoadrenal medullary (SAM) axis may activate the fight or flight response through the sympathetic nervous system , which dedicates energy to more relevant bodily systems to acute adaption to stress, while the parasympathetic nervous system returns the body to homeostasis. The second major physiological stress, the HPA axis regulates the release of cortisol , which influences many bodily functions such as metabolic, psychological and immunological functions. The SAM and HPA axes are regulated by a wide variety of brain regions, including the limbic system , prefrontal cortex , amygdala , hypothalamus , and stria terminalis . Through these mechanisms, stress can alter memory functions, reward , immune function , metabolism and susceptibility to diseases. Definitions of stress differ; however, one system proposed by Elliot and Eisdorfer suggests five types of stress. The five types of stress are labeled "acute time limited stressors", "brief naturalistic stressors", "stressful event sequence", "chronic stressors", and "distant stressors". Acute time limited stressors involve short term challenges, while, on the other hand, brief naturalistic stressors involve an event that is normal but nevertheless challenging. Stressful event sequences are a stressor that occur, and continue to yield stress into the immediate future. Chronic stressors are involve exposure to a long-term stressor and a distant stressor is a stressor that isn't immediate.
* 1 Overview
* 2 Etymology and historical usage
* 3 Biological need for equilibrium
* 4 Biological background
* 6 Effects of chronic stress
* 6.1 Immunological * 6.2 Infectious * 6.3 Chronic disease * 6.4 Development * 6.5 Psychopathology
* 7 Psychological concepts
* 7.1 Eustress * 7.2 Coping * 7.3 Cognitive appraisal
* 8 Assessment
* 8.1 Assessment
* 8.3 General adaptation syndrome
* 8.3.1 Stage 1 * 8.3.2 Stage 2 * 8.3.3 Stage 3
* 9 History in research * 10 See also * 11 Notes * 12 References * 13 External links
THIS ARTICLE OR SECTION MAY NEED TO BE CLEANED UP. It has been merged from Stress (psychology)#Impact on health .
There likely is a connection between stress and illness. Several studies have suggested such a link, theories of the stress–illness link suggest that both acute and chronic stress can cause illness. According to these studies, both acute and chronic stress can lead to changes in behavior and in physiology. Behavioral changes can include smoking, changes in eating habits and physical activity. Physiological changes can include changes in sympathetic activation or HPA activity, and immunological function. However, there is much variability in the link between stress and illness.
The HPA axis regulates many bodily functions, both behavioral and physiological, through the release of glucocorticoid hormones . The HPA axis activity varies according to the circadian rhythm , with a spike in the morning. The axis involves the release of corticotropin releasing hormone and vasopressin from the hypothalamus which stimulates the pituitary to secrete ACTH . ACTH may then stimulate the adrenal glands to secrete cortisol . The HPA axis is subject to negative feedback regulation as well. The release of CRH and VP are regulated by descending glutaminergic and GABAergic pathways from the amygdala, as well as noradrenergic projections. Increased cortisol usually acts to increase blood glucose, blood pressure, and surpasses lysosomal, and immunological activity. Under other circumstances, however, the activity may differ. Increased cortisol also favors habit based learning, by favoring memory consolidation of emotional memories.
Selye demonstrated that stress decreases adaptability of an organism and proposed to describe the adaptability as a special resource, adaptation energy. In recent works, it is considered as an internal coordinate on the "dominant path" in the model of adaptation. Stress can make the individual more susceptible to physical illnesses like the common cold. Stressful events, such as job changes, may result in insomnia, impaired sleeping, and physical and psychological health complaints. Research indicates the type of stressor (whether it's acute or chronic) and individual characteristics such as age and physical well-being before the onset of the stressor can combine to determine the effect of stress on an individual. An individual's personality characteristics (such as level of neuroticism), genetics, and childhood experiences with major stressors and traumas may also dictate their response to stressors.
Chronic stress and a lack of coping resources available or used by an individual can often lead to the development of psychological issues such as delusions depression and anxiety (see below for further information). This is particularly true regarding chronic stressors. These are stressors that may not be as intense as an acute stressor like a natural disaster or a major accident, but they persist over longer periods of time. These types of stressors tend to have a more negative effect on health because they are sustained and thus require the body's physiological response to occur daily. This depletes the body's energy more quickly and usually occurs over long periods of time, especially when these microstressors cannot be avoided (i.e. stress of living in a dangerous neighborhood). See allostatic load for further discussion of the biological process by which chronic stress may affect the body. For example, studies have found that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse physical health than noncaregivers.
It has long been believed that negative affective states, such as feelings of anxiety and depression, could influence the pathogenesis of physical disease. However recent studies done by the University of Wisconsin-Madison and other places have shown this to be untrue, it isn't stress itself that causes the increased risk of illness or death, it is actually the perception that stress is harmful. For example, when humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses are most likely to occur and such changes could lead to disease. Chronic stress can include events such as caring for a spouse with dementia, or results from brief focal events that with long term effects, such as experiencing a sexual assault. Studies have also showed that psychological stress may directly contribute to the disproportionately high rates of coronary heart disease morbidity and mortality and its etiologic risk factors . Specifically, acute and chronic stress have been shown to raise serum lipids and are associated with clinical coronary events.
However, it is possible for individuals to exhibit hardiness —a
term referring to the ability to be both chronically stressed and
healthy. Even though psychological stress is often connected with
illness or disease, most healthy individuals can still remain
disease-free after being confronted with chronic stressful events.
This suggests that there are individual differences in vulnerability
to the potential pathogenic effects of stress; individual differences
in vulnerability arise due to both genetic and psychological factors.
In addition, the age at which the stress is experienced can dictate
its effect on health. Research suggests chronic stress at a young age
can have lifelong effects on the biological, psychological, and
behavioral responses to stress later in life. Recent studies have
shown that severe psychological stress resulting in
In animals, stress contributes to the initiation, growth, and metastasis of select tumors, but studies that try to link stress and cancer incidence in humans have had mixed results. This can be due to practical difficulties in designing and implementing adequate studies.
ETYMOLOGY AND HISTORICAL USAGE
The term "stress" had none of its contemporary connotations before
the 1920s. It is a form of the
Middle English destresse, derived via
Old French from the
Walter Cannon used it in 1926 to refer to external factors that disrupted what he called homeostasis . But "...stress as an explanation of lived experience is absent from both lay and expert life narratives before the 1930s". Physiological stress represents a wide range of physical responses that occur as a direct effect of a stressor causing an upset in the homeostasis of the body. Upon immediate disruption of either psychological or physical equilibrium the body responds by stimulating the nervous , endocrine , and immune systems . The reaction of these systems causes a number of physical changes that have both short- and long-term effects on the body.
The Holmes and Rahe stress scale was developed as a method of assessing risk of disease from life changes. The scale lists both positive and negative changes that elicit stress. These include things such as a major holiday or marriage, or death of a spouse and firing from a job.
BIOLOGICAL NEED FOR EQUILIBRIUM
Homeostasis is a concept central to the idea of stress. In biology , most biochemical processes strive to maintain equilibrium (homeostasis), a steady state that exists more as an ideal and less as an achievable condition. Environmental factors, internal or external stimuli, continually disrupt homeostasis; an organism's present condition is a state of constant flux moving about a homeostatic point that is that organism's optimal condition for living. Factors causing an organism's condition to diverge too far from homeostasis can be experienced as stress. A life-threatening situation such as a major physical trauma or prolonged starvation can greatly disrupt homeostasis. On the other hand, an organism's attempt at restoring conditions back to or near homeostasis, often consuming energy and natural resources, can also be interpreted as stress.
The ambiguity in defining this phenomenon was first recognized by Hans Selye (1907–1982) in 1926. In 1951 a commentator loosely summarized Selye's view of stress as something that "...in addition to being itself, was also the cause of itself, and the result of itself".
First to use the term in a biological context, Selye continued to define stress as "the non-specific response of the body to any demand placed upon it". As of 2011 neuroscientists such as Bruce McEwen and Jaap Koolhaas believe that stress, based on years of empirical research, "should be restricted to conditions where an environmental demand exceeds the natural regulatory capacity of an organism".
Stress can have many profound effects on the human biological
Stress, either severe, acute stress or chronic low-grade stress may induce abnormalities in three principal regulatory systems in the body: serotonin systems , catecholamine systems , and the hypothalamic-pituitary-adrenocortical axis . Aggressive behavior has also been associated with abnormalities in these systems.
BIOLOGY OF STRESS
Human brain: Hypothalamus = , amygdala = , hippocampus/fornix = , pons= , pituitary gland=
The brain endocrine interactions are relevant in the translation of stress into physiological and psychological changes. The autonomic nervous system (ANS), as mentioned above, plays an important role in translating stress into a response. The ANS responds reflexively to both physical stressors (for example baroreception), and to higher level inputs from the brain. The ANS is composed of the parasympathetic nervous system and sympathetic nervous system , two branches that are both tonically active with opposing activities. The ANS directly innervates tissue through the postganglionic nerves, which is controlled by preganglionic neurons originating in the intermediolateral cell column . The ANS receives inputs from the medulla , hypothalamus , limbic system , prefrontal cortex , midbrain and monoamine nuclei . The activity of the sympathetic nervous system drives what sometimes called the "fight or flight" response. The fight or flight response to emergency or stress involves mydriasis , increased heart rate and force contraction, vasoconstriction , bronchodilation , glycogenolysis , gluconeogenesis , lipolysis , sweating , decreased motility of the digestive system, secretion of the epinephrine and cortisol from the adrenal medulla, and relaxation of the bladder wall. The parasympathetic nervous response, "rest and digest", involves return to maintaining homeostasis, and involves miosis , bronchoconstriction , increased activity of the digestive system, and contraction of the bladder walls. Complex relationships between protective and vulnerability factors on the effect of childhood home stress on psychological illness, cardiovascular illness and adaption have been observed. ANS related mechanisms are thought to contribute to increased risk of cardiovascular disease after major stressful events
HPA axis is a neuroendocrine system that mediates a stress
response. Neurons in the hypothalamus, particularly the
paraventricular nucleus , release vasopressin and corticotropin
releasing hormone , which travels through the hypophysial portal
vessel where it travels to and binds to corticotropin-releasing
hormone receptor on the anterior pituitary gland . Multiple CRH
peptides have been identified, and receptors have been identified on
multiple areas of the brain, including the amygdala. However, CRH is
the main regulatory molecule of the release of ACTH. The secretion of
ACTH into systemic circulation allows it to bind to and activate
Melanocortin receptor , where it stimulates the release of steroid
The immune system may be heavily influenced by stress. The sympathetic nervous system innervates various immunological structures, such as bone marrow and the spleen , allowing for it to regulate immune function. The adrenergic substances released by the sympathetic nervous system can also bind to and influence various immunological cells, further providing a connection between the systems. The HPA axis ultimately results in the release of cortisol, which generally has immunosuppressive effects. However, the effect of stress on the immune system is disputed, and various models have been proposed in an attempt to account for both the supposedly "immunodeficiency" linked diseases and diseases involving hyper activation of the immune system. The most recent model proposed to account for this suggests an push towards an imbalance of cellular immunity (Th1) and humoral immunity (Th2). The proposed imbalance involved hyperactivity of the Th2 system leading to some forms of immune hypersensitivity , while also increasing risk of some illnesses associated with decreased immune system function, such as infection and cancer .
EFFECTS OF CHRONIC STRESS
Main article: Chronic stress
Chronic stress is a term sometimes used to differentiate between acute stress. Definitions differ, and may be along the lines of continual activation of the stress response, stress that causes an allostatic shift in bodily functions, or just as "prolonged stress". For example, results of one study demonstrated that individuals who reported relationship conflict lasting one month or longer have a greater risk of developing illness and show slower wound healing. Similarly, the effects that acute stressors have on the immune system may be increased when there is perceived stress and/or anxiety due to other events. For example, students who are taking exams show weaker immune responses if they also report stress due to daily hassles. While responses to acute stressors typically do not impose a health burden on young, healthy individuals, chronic stress in older or unhealthy individuals may have long-term effects that are detrimental to health.
Acute time limited stressors, or stressors that lasted less than two
hours, results in an up regulation of natural immunity and down
regulation of specific immunity . This type of stress saw in increase
in granulocytes , natural killer cells ,
Some studies have observed increased risk of upper respiratory tract infection during chronic life stress. In patients with HIV, increased life stress and cortisol was associated with poorer progression of HIV.
A link has been suggested between chronic stress and cardiovascular disease. Stress appears to play a role in hypertension , and may further predispose people to other conditions associated with hypertension. Stress may also precipitate a more serious, or relapse into abuse of alcohol. Stress may also contribute to aging and chronic diseases in aging, such as depression and metabolic disorders. The immune system also plays a role in stress and the early stages of wound healing . It is responsible for preparing the tissue for repair and promoting recruitment of certain cells to the wound area. Consistent with the fact that stress alters the production of cytokines, Graham et al. found that chronic stress associated with care giving for a person with Alzheimer's disease leads to delayed wound healing. Results indicated that biopsy wounds healed 25% more slowly in the chronically stressed group, or those caring for a person with Alzheimer's disease.
Chronic stress has also been shown to impair developmental growth in children by lowering the pituitary gland 's production of growth hormone, as in children associated with a home environment involving serious marital discord, alcoholism , or child abuse .
More generally, prenatal life, infancy, childhood, and adolescence are critical periods in which the vulnerability to stressors is particularly high.
Chronic stress is seen to affect the parts of the brain where memories are processed through and stored. When people feel stressed, stress hormones get over-secreted, which affects the brain. This secretion is made up of glucocorticoids , including cortisol , which are steroid hormones that the adrenal gland releases, although this can increase storage of flashbulb memories it decreases long-term potentation (LTP). The hippocampus is important in the brain for storing certain kinds of memories and damage to the hippocampus can cause trouble in storing new memories but old memories, memories stored before the damage, are not lost. Also high cortisol levels can be tied to the deterioration of the hippocampus and decline of memory that many older adults start to experience with age.
Chronic stress also shifts learning, forming a preference for habit based learning , and decreased task flexibility and spatial working memory , probably through alterations of the dopaminergic systems . Stress may also increase reward associated with food, leading to weight gain and further changes in eating habits. Stress may contribute to various psychosomatic disorders, such as fibromyalgia , chronic fatigue syndrome , depression , and functional somatic syndromes .
Main article: Stress (psychological)
Selye published in year 1975 a model dividing stress into eustress and distress . Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress. Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behavior.
The difference between experiences that result in eustress and those that result in distress is determined by the disparity between an experience (real or imagined) and personal expectations, and resources to cope with the stress. Alarming experiences, either real or imagined, can trigger a stress response.
Main article: Stress management
Responses to stress include adaptation, psychological coping such as stress management , anxiety, and depression . Over the long term, distress can lead to diminished health and/or increased propensity to illness; to avoid this, stress must be managed.
Stress management encompasses techniques intended to equip a person with effective coping mechanisms for dealing with psychological stress, with stress defined as a person's physiological response to an internal or external stimulus that triggers the fight-or-flight response. Stress management is effective when a person uses strategies to cope with or alter stressful situations.
There are several ways of coping with stress, such as controlling the source of stress or learning to set limits and to say "no" to some of the demands that bosses or family members may make.
A person's capacity to tolerate the source of stress may be increased by thinking about another topic such as a hobby, listening to music, or spending time in a wilderness .
A way to control stress is first dealing with what is causing the stress if it is something the individual has control over. Other methods to control stress and reduce it can be: to not procrastinate and leave tasks for last minute, do things you like, exercise, do breathing routines, go out with friends, and take a break. Having support from a loved one also helps a lot in reducing stress.
A study was done and it showed that the power of having support from a loved one or just social support, lowered stress in the individuals. They gave painful shocks to married women's ankles. On some trials women were able to hold their husbands hand, on other trials they held a strangers hand, and then held no one's hand. When the women were holding their husbands hand, the response reduced in many brain areas. When holding the strangers hand the response reduced a little but not as much as when they were holding their husbands hand. Social support helps reduce stress but even more if the support is from a loved one.
Lazarus argued that, in order for a psychosocial situation to be stressful, it must be appraised as such. He argued that cognitive processes of appraisal are central in determining whether a situation is potentially threatening, constitutes a harm/loss or a challenge, or is benign.
Both personal and environmental factors influence this primary appraisal, which then triggers the selection of coping processes. Problem-focused coping is directed at managing the problem, whereas emotion-focused coping processes are directed at managing the negative emotions. Secondary appraisal refers to the evaluation of the resources available to cope with the problem, and may alter the primary appraisal.
In other words, primary appraisal includes the perception of how stressful the problem is and the secondary appraisal of estimating whether one has more than or less than adequate resources to deal with the problem that affects the overall appraisal of stressfulness. Further, coping is flexible in that, in general, the individual examines the effectiveness of the coping on the situation; if it is not having the desired effect, s/he will, in general, try different strategies.
Main articles: Holmes and Rahe stress scale and Stress (psychological)
A renewed interest in salivary alpha amylase as a marker for stress has surfaced. Yamaguchi M, Yoshida H (2005) have analyzed a newly introduced hand-held device called the Cocorometer developed by Nipro Corporation of Japan. They state that this can be reliably used to analyze the amylase levels and is definitely a cheaper alternative as compared to the more expensive ELISA kits. The working consists of a meter and a saliva collecting chip, which can be inserted into the meter to give the readings. The levels of amylase obtained have been calibrated according to standard population, and can be categorized into four levels of severity.
Measuring stress levels independent of differences in people's personalities has been inherently difficult: Some people are able to process many stressors simultaneously, while others can barely address a few. Such tests as the Trier Social Stress Test attempted to isolate the effects of personalities on ability to handle stress in a laboratory environment. Other psychologists, however, proposed measuring stress indirectly, through self-tests.
Because the amount of stressors in a person's life often (although not always) correlates with the amount of stress that person experiences, researchers combine the results of stress and burnout self-tests. Stress tests help determine the number of stressors in a person's life, while burnout tests determine the degree to which the person is close to the state of burnout. Combining both helps researchers gauge how likely additional stressors will make him or her experience mental exhaustion.
HEALTH RISK FACTORS
Both negative and positive stressors can lead to stress. The intensity and duration of stress changes depending on the circumstances and emotional condition of the person suffering from it (Arnold. E and Boggs. K. 2007). Some common categories and examples of stressors include:
* Sensory input such as pain , bright light , noise, temperatures, or environmental issues such as a lack of control over environmental circumstances, such as food , air and/or water quality, housing , health , freedom , or mobility. * Social issues can also cause stress, such as struggles with conspecific or difficult individuals and social defeat , or relationship conflict, deception , or break ups , and major events such as birth and deaths , marriage , and divorce . * Life experiences such as poverty , unemployment , clinical depression , obsessive compulsive disorder , heavy drinking , or insufficient sleep can also cause stress. Students and workers may face performance pressure stress from exams and project deadlines. * Adverse experiences during development (e.g. prenatal exposure to maternal stress, poor attachment histories, sexual abuse ) are thought to contribute to deficits in the maturity of an individual's stress response systems. One evaluation of the different stresses in people's lives is the Holmes and Rahe stress scale .
GENERAL ADAPTATION SYNDROME
A diagram of the General Adaptation Syndrome model.
Physiologists define stress as how the body reacts to a stressor, real or imagined, a stimulus that causes stress. Acute stressors affect an organism in the short term; chronic stressors over the longer term. The general adaptation syndrome (GAS), developed by Hans Selye, is a profile of how organisms respond to stress; GAS is characterized by three phases: a nonspecific mobilization phase, which promotes sympathetic nervous system activity; a resistance phase, during which the organism makes efforts to cope with the threat; and an exhaustion phase, which occurs if the organism fails to overcome the threat and depletes its physiological resources.
ALARM is the first stage, which is divided into two phases: the shock phase and the antishock phase.
* Shock phase: During this phase, the body can endure changes such as hypovolemia , hypoosmolarity , hyponatremia , hypochloremia , hypoglycemia —the stressor effect. This phase resembles Addison\'s disease . The organism's resistance to the stressor drops temporarily below the normal range and some level of shock (e.g. circulatory shock ) may be experienced. * Antishock phase: When the threat or stressor is identified or realized, the body starts to respond and is in a state of alarm. During this stage, the locus coeruleus /sympathetic nervous system is activated and catecholamines such as adrenaline are being produced, hence the fight-or-flight response . The result is: increased muscular tonus , increased blood pressure due to peripheral vasoconstriction and tachycardia , and increased glucose in blood. There is also some activation of the HPA axis , producing glucocorticoids (cortisol , aka the S-hormone or stress-hormone).
RESISTANCE is the second stage and increased secretion of glucocorticoids play a major role, intensifying the systemic response—they have lipolytic, catabolic and antianabolic effects: increased glucose, fat and amino acid/protein concentration in blood. Moreover, they cause lymphocytopenia, eosinopenia, neutrophilia and polycythemia. In high doses, cortisol begins to act as a mineralocorticoid (aldosterone) and brings the body to a state similar to hyperaldosteronism . If the stressor persists, it becomes necessary to attempt some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted.
The third stage could be either exhaustion or recovery:
* RECOVERY stage follows when the system's compensation mechanisms have successfully overcome the stressor effect (or have completely eliminated the factor which caused the stress). The high glucose, fat and amino acid levels in blood prove useful for anabolic reactions, restoration of homeostasis and regeneration of cells. * EXHAUSTION is the alternative third stage in the GAS model. At this point, all of the body's resources are eventually depleted and the body is unable to maintain normal function. The initial autonomic nervous system symptoms may reappear (sweating, raised heart rate, etc.). If stage three is extended, long-term damage may result (prolonged vasoconstriction results in ischemia which in turn leads to cell necrosis), as the body's immune system becomes exhausted, and bodily functions become impaired, resulting in decompensation .
The result can manifest itself in obvious illnesses, such as peptic ulcer and general trouble with the digestive system (e.g. occult bleeding , melena , constipation /obstipation), diabetes , or even cardiovascular problems (angina pectoris ), along with clinical depression and other mental illnesses.
HISTORY IN RESEARCH
The current usage of the word stress arose out of Selye 's 1930s experiments. He started to use the term to refer not just to the agent but to the state of the organism as it responded and adapted to the environment. His theories of a universal non-specific stress response attracted great interest and contention in academic physiology and he undertook extensive research programs and publication efforts.
While the work attracted continued support from advocates of psychosomatic medicine , many in experimental physiology concluded that his concepts were too vague and unmeasurable. During the 1950s, Selye turned away from the laboratory to promote his concept through popular books and lecture tours. He wrote for both non-academic physicians and, in an international bestseller entitled Stress of Life, for the general public.
A broad biopsychosocial concept of stress and adaptation offered the promise of helping everyone achieve health and happiness by successfully responding to changing global challenges and the problems of modern civilization . Selye coined the term "eustress " for positive stress, by contrast to distress . He argued that all people have a natural urge and need to work for their own benefit, a message that found favor with industrialists and governments. He also coined the term stressor to refer to the causative event or stimulus, as opposed to the resulting state of stress.
From the late 1960s, academic psychologists started to adopt Selye's
concept; they sought to quantify "life stress" by scoring "significant
life events ," and a large amount of research was undertaken to
examine links between stress and disease of all kinds. By the late
1970s, stress had become the medical area of greatest concern to the
general population, and more basic research was called for to better
address the issue. There was also renewed laboratory research into the
neuroendocrine , molecular , and immunological bases of stress,
conceived as a useful heuristic not necessarily tied to Selye's
original hypotheses. The
The psychiatric diagnosis post-traumatic stress disorder (PTSD) was
coined in the mid-1970s, in part through the efforts of anti-Vietnam
War activists and the
Vietnam Veterans Against the War , and Chaim F.
Shatan . The condition was added to the Diagnostic and Statistical
Manual of Mental Disorders as posttraumatic stress disorder in 1980.
By the 1990s, "stress" had become an integral part of modern scientific understanding in all areas of physiology and human functioning, and one of the great metaphors of Western life. Focus grew on stress in certain settings, such as workplace stress , and stress management techniques were developed. The term also became a euphemism , a way of referring to problems and eliciting sympathy without being explicitly confessional, just "stressed out". It came to cover a huge range of phenomena from mild irritation to the kind of severe problems that might result in a real breakdown of health . In popular usage, almost any event or situation between these extremes could be described as stressful.
The American Psychological Association's 2015 Stress In America Study found that nationwide stress is on the rise and that the three leading sources of stress were "money", "family responsibility", and "work".
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