So, I’m Stressed. Is That Really So Bad?

Answer: It could be. Stress kills. Rarely, but not never. And then there is anxiety, which subsumes a host of related diagnoses. The terms are often co-mingled, with the latter tending to diffuse the dangers of the former. Let’s take a deeper look.
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What Doesn’t Kill Us, Makes Us Stronger? Maybe not.

The prevailing view is some stress is good for us. Even “bad stress,” optimally managed, is rarely likely to kill you. On the other hand, “bad stress” isn’t good for you, possibly leading to adverse health and certainly less “quality” to your life.   As for the difference between stress and anxiety - that depends on whom you ask. [1]

Psychologists tend to see anxiety as internally driven; physiologists, looking at the biological impact, claim it is triggered by events both within and without the body, just like stress.  Some researchers consider chronic stress the trigger for anxiety, suggesting the latter is worse. Others note outcomes, like cancer or death, are associated with stress, without mentioning anxiety.

There doesn’t seem to be much effort expended on distinguishing the two conditions in terms of research, diagnostics, or treatment. But some problems facing sufferers of the two conditions (if they really are separate) are the same – like being prescribed the same anti-depressant medications. The co-mingling of terms, however, leads to confusion and might tend to dilute the dangers.

Stressors, which are influencers triggering biological responses, can be internal or external, under or outside our control. The actual physiological response does not necessarily differ depending on the precipitating cause.

The most commonly experienced effects of stress and anxiety include:

  • increased chronic pain
  • weakened immune system
  • agitated gastrointestinal (GI) functioning, abdominal discomfort, diarrhea
  • tension, muscle-tightening in the neck or lower back
  • high blood pressure
  • poor or disrupted sleep

Most of us are familiar with the indirect effects of prolonged stress and anxiety on healthy behaviors. These include irregular eating patterns, spur-of-the-moment meals, fostering smoking and drinking, and avoiding health appointments and exercise. Chronic stress would encompass what we might colloquially call “anxiety.”

Less commonly recognized are the most severe consequences of stress, which can result in significant cardiovascular problems, cancer, and cognitive and neurological issues. Chronic stress and related anxiety, such as panic disorders and phobias, can also wreak havoc on the brain and coping mechanisms, spiraling the initial impact.

Stress and the Heart

“The existence of an important relationship between stress, the autonomic nervous system, and sudden cardiac death (SCD) has been long recognized…. These conditions include external stressors (earthquakes, wars) and internal stressors (anger, fear, loss of a loved one) and emotions …. An interesting facet of this potentially lethal relationship is that the elements involved are by no means always exceptional, and they can actually represent part of our everyday life.”

Professor Maria Theresa La Rovere            

The stress responses, properly controlled, are healthy, catapulting the body into high alert to deal with emergencies. Unnecessary functions are shut down, and all available ammo or resources are deployed to the firing ranges. The problems arise when the response doesn’t shut off- either because we are constantly subjected to real or misperceived false threats or fails to shut off on its own.

All stressors stimulate the autonomic nervous system, particularly the “sympathetic component, which activates the body’s “fight or flight” response. The heightened response increases heart rate and blood pressure. Elevated levels of norepinephrine and epinephrine redistribute blood volume to our muscles and brain, those body parts needing extra oxygen facilitating our responses to threats or danger. When the danger is over, assuming all is in working order, the parasympathetic nervous system shuts down the war response, and the body returns to its resting state.

When subjected to chronic stress, such as major depressive disorder, repetitive acute stress, or intense stress, the sympathetic nervous system remains continuously activated. The resultant prolonged increased blood pressure and increased or irregular heart rate places an additional physiologic burden on the body. This maladaptive response can also affect our minds, resulting in depression, anxiety, and cognitive impairment.

One recent literature review noted the direct relationship between stress, used interchangeably with anxiety and sudden cardiac arrest. In these cases, electrolyte imbalance generated by prolonged stress exposure resulted in irregular heart rhythms leading to heart attack (myocardial infarction).

The impact of consistent and uncontrolled high blood pressure is a more chronic path to cardiovascular disease. The constant pressure on the arterial walls, already carrying a burden of atherosclerotic disease, can further weaken and, like a tire, balloon out (creating an aneurysm) or blow out, leading to hemorrhage and death. Additionally, the heart must work harder to sustain the higher blood pressure, setting the stage for a heart attack from “overwork.”  

Another fairly recent study examined the relationship between changes in the amygdala (a brain region associated with stress) and cardiac events.  Monitoring by PET scans, a form of imaging of the brain’s metabolism, demonstrated a causal and predictive relationship. Another signaling pathway is activated by the hypothalamus,  a small region at the brain’s base alarming the body and promoting the secretion of two stress-related hormones, adrenaline, and cortisol. The adrenaline augments the heart rate, increasing blood pressure. In the short term, this effect is energizing but can be dangerous if it continues unabated long term.

Unrelenting cortisol production is more treacherous and less dramatic.  In good times, it enhances the brain’s use of glucose and tissue repair, suppressing non-critical functions. But like the sorcerer’s apprentice, its constant production without shutoff dysregulates immune and cognitive functions and impairs mood regulation. 

Stress and Cancer

Recent work now reports a connection between stress and cancer. Not acute or dramatic stress, but the stress of life events and sub-optimal lifestyle, often due to adverse socio-economic and other constraints outside our control, such as race or income.

Last year, a retrospective study using the NHANES database reported an increase in cancer-related mortality of 14% could be associated with the strain of the body’s “allostatic load,” a measure of tissue wear and tear occasioned by stress. In those under 40, the increase rose to 80%.

Exposure to stress can [apparently] cause pathophysiologic changes in the brain, … manifested as behavioral, cognitive, and mood disorders …, [and]  chronic stress can cause complications such as increased IL-6 and plasma cortisol, …very similar to what is observed in people with depression and mood disorders that exhibit a wide range of cognitive problems. … But even if you take race out, the bottom line is that the environments in which we live, work, and play,… [are] conducive to high stress, which in turn may lead to cancer development and increased morbidity and mortality.”

Dr. Justin Xavier Moore, epidemiologist, Georgia Cancer Center.

The adverse health consequences of stress, acute and chronic, are likely to generate further stress – spiraling the body’s response. The best answer is to prevent the body from going into stress overdrive or encouraging it to shut off when possible—more on this next time.              


[1] “Anxiety is a person’s specific reaction to stress; its origin is internal. Anxiety is typically characterized by a “persistent feeling of apprehension or dread” in situations that are not actually threatening. Unlike stress, anxiety persists even after a concern has passed. In more severe cases, anxiety can escalate into an anxiety disorder, the most common mental health issue in the U.S. Anxiety disorders are classified in a variety of ways: generalized anxiety, panic disorder, phobias, social anxiety, obsessive-compulsive disorder and post-traumatic stress disorder (PTSD)…. Stress is a common trigger for anxiety, and it’s important to catch anxiety symptoms early to prevent development of an anxiety disorder.” - National Council for Mental Well-Being

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