Stress – signs, causes and management

Written by Dr Katie Stephens, GP

Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP). 

What is stress?

The definition of stress varies from one researcher to the next, but loosely it can be considered in terms of a ‘stressor’ (an event or situation outside of oneself) that triggers a ‘stress response’ (this can be both a physiological change in the body such as an increase in stress hormones, and an emotional feeling).

You may be wondering, are stress and anxiety the same thing? This is a complex question to answer but they are certainly linked, to say the least. We know that they share similar neurological and hormonal pathways in the body¹. Some researchers believe that anxiety is the psychological component of the body’s response to a stressor.

What are the signs of being stressed?

In the acute setting, the classic signs of being stressed are the ‘fight or flight’ symptoms that we all are familiar with. As the adrenaline pumps up, we may feel our heart racing or beating more strongly, we might start to breathe more quickly, start perspiring or potentially even feel lightheaded or faint. Some people experience gastrointestinal symptoms such as a ‘nervous tummy’. We might feel anxious, hyper-sensitive to loud noises, or panicked.

Over time with sustained high levels of stress, we may notice hair loss, sleep disturbance, weight fluctuations, absent periods for menstruating women, or erectile dysfunction for men. Our mood may take a more prolonged dip into irritability, depression or anxiety.

What are common causes of stress?

I think it can be helpful to think of the causes in terms of life events and chronic stressors:

Life events

The life events typically associated with the highest levels of stress include: losing a loved one, getting separated or divorced, moving house, starting a new job, and getting married, not to mention the more extreme examples of being affected by a natural disaster or war. However, you don’t have to have a major life event like these to feel stressed. Missing a bus when you’re running late, feeling like you need to cram too much into a day, or just navigating a conflict with a friend or co-worker can all cause significant short-term stress.

Chronic Stressors

By these I mean stressors which tend to me more persistent, ongoing issues and may also be less visible to others around you. Common examples are financial concerns, having had a difficult childhood, relationship strains, work stress, caring for a poorly family member, social isolation or worries about politics or the world at large.

Can being stressed lead to heart problems including heart attacks and strokes?

Absolutely. There are huge amounts of evidence for stress causing Coronary Heart Disease (examples of this are angina and heart attacks), raised blood pressure and stroke, amongst other problems. A fairly dramatic example of how stress can affect the heart is a recognised condition called Takotsubo Cardiomyopathy, or Broken Heart Syndrome². This is where severe emotional (or physical) stress triggers a sudden change in the shape of the left ventricle, which is the main chamber of the heart responsible for pumping blood around the body. The new shape resembles a pot used in Japan for trapping octopuses, called a ‘takotsubo’. Unfortunately, this new shape is not very good at pumping blood, which makes the condition very dangerous. Symptoms of this mimic a heart attack and include chest pain and shortness of breath.

We know that acute stress can lead to generic heart attacks also – one study of some 2000 participants showed that the rate of having a heart attack goes up 21-fold in the 24 hours after losing a loved one³. Another study explored the science behind stress causing heart attacks. It compared two groups of people who had suffered from heart attacks – one whose events had been triggered by stress versus a group with non-triggered heart attacks. Interestingly, in the triggered group, it found that acute stress events produced two distinct differences versus the non-triggered group: when they had to do something stressful, those in the triggered group were found to have raised levels of chemicals involved in forming blood clots, as well as a blood pressure that stayed high for longer⁴.

The above examples all involve sudden onset, or acute, stressors. Unfortunately, it appears that chronic stressors like the ones listed above can also cause heart disease and may be associated with a 60% greater risk of Coronary Heart Disease⁵.

Does stress cause high blood pressure?

While it may be somewhat controversial, there is some evidence that stress (particularly chronic stress) may cause hypertension. This isn’t a definite conclusion for all people – as mentioned in the previous section, it seems that certain people are more susceptible to having a different physiological response to acute/short-term stress, with a propensity for some to have high blood pressure that lasts longer than for others.

The link between chronic stressors and hypertension is less controversial and there does seem to be reasonable evidence behind the thought that hypertension can be caused by chronic stress⁶.

Does stress lead to other non-heart-related issues?

There is also evidence of links between stress and obesity, and between stress and unhealthy cholesterol levels, with a trend towards raised triglycerides (bad cholesterol) and lower HDL (good) cholesterol seen⁵. And of course, stress can affect many different parts of the body, and can be linked to conditions such as alopecia (hair loss), erectile dysfunction, Irritable Bowel Syndrome and tension headaches just to name a few.

How can I deal with (manage) stress?

The best way of doing this will look different for each person. You are probably already aware of certain things that you’ve done in the past in response to stress that have either been helpful or potentially had the opposite effect. Drs Emily and Amelia Nagoski’s book ‘Burnout: The Secret to Unlocking the Stress Cycle’ gives some fantastic practical advice in this regard. In brief, the following actions seem to help move our bodies out of the stress response⁷; be warned that some may suit you more naturally and so be more likely to help than others!

• Any kind of physical movement
• Deep slow breathing
• Positive social interaction
• Laughter
• Affection
• Cathartic crying
• Creative self-expression

Exercise, of course, is a commonly used stress reliever – going for a run or hitting a punching bag can be both therapeutic in reducing stress levels while simultaneously having a direct benefit on heart health⁸.

The take away message here is that high intensity exercise isn’t the only option for managing stress, especially for anyone unable to or averse to exercise for whatever reason. Being aware of other healthy ways to reduce stress can be really useful (and of course the above list is not exhaustive, and doesn’t include meditation which there is also evidence for⁹). It is especially worth referring to this list if you think your current methods of managing stress may not be helpful in the long term.

For more tips on boosting heart health, you can read my blog here, or check out my references below.

References

1. Daviu N, Bruchas MR, Moghaddam B, Sandi C, Beyeler A. Neurobiological links between stress and anxiety Stress, 11 (2019), p. 100191, https://doi.org/10.1016/j.ynstr.2019.100191
2. https://www.cardiomyopathy.org/about-cardiomyopathy/types-cardiomyopathy/takotsubo-cardiomyopathy
3. Mostofsky E, Maclure M, Sherwood JB, Tofler GH, Muller JE, Mittleman MA. 2012. Risk of acute myocardial infarction after the death of a significant person in one’s life: the Determinants of Myocardial Infarction Onset Study. Circulation 125:491–96 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.061770
4. Strike PC, Magid K, Whitehead DL, Brydon L, Bhattacharyya MR, Steptoe A. 2006. Pathophysiological processes underlying emotional triggering of acute cardiac events. Proc. Natl. Acad. Sci. USA 103:4322–27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449691/
5. Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013;34:337-54. doi: 10.1146/annurev-publhealth-031912-114452. Epub 2013 Jan 7. PMID: 23297662. https://pubmed.ncbi.nlm.nih.gov/23297662/
6. Mei-Yan Liu, Na Li, William A. Li & Hajra Khan (2017) Association between psychosocial stress and hypertension: a systematic review and meta-analysis, Neurological Research, 39:6, 573-580, DOI: 1080/01616412.2017.1317904
7. Nagoski A, Nagoski E. Burnout: The Secret to Unlocking the Stress Cycle. Ballantine Books, Jan 2020. https://www.burnoutbook.net/
8. https://www.kinetikwellbeing.com/10-tips-for-a-healthy-heart/
9. Dimsdale J, Mills P. An unanticipated effect of meditation on cardiovascular pharmacology and physiology. Am J Cardiol 2002;90:908–9. https://www.ajconline.org/article/S0002-9149(02)02726-1/fulltext