What is stress?

Stress is defined as "any stimulus, such as fear or pain, that disturbs or interferes with the normal physiologic equilibrium of an organism." We all experience stress in our everyday lives. Commitments to work or family life, time pressures, financial pressures and difficulties in personal relationships can all be important sources of stress. As the definition implies, stress upsets the normal equilibrium or balance in one's life.

In some instances, stress may play a beneficial role. Imagine you are walking down a dark alley and see a stranger running toward you. A surge of adrenaline heightens your readiness and ability to escape a potentially dangerous situation.

Stress may be helpful in other ways. Some people do their best work when under the stress of a deadline. An athlete or musician may perform better with the stress that comes from competition. Yet, despite these examples, it is also clear that stress can disrupt people to the point that their ability to function is compromised.

What is the relationship between stress and physical illness?

This is an interesting question and one that has not been fully answered. Illness of any kind disrupts routines and interferes with day-to-day functions, all of which stresses an individual.

A person's response to the stress of physical illness varies tremendously and in large part depends on his or her own personality style and social supports. It is known, for example, that certain diseases such as diabetes, rheumatoid arthritis, peptic ulcer disease, or cardiac disease can worsen with mental stress. While it is not clear that stress causes these diseases, it is clear that these and probably many other illnesses are influenced by stress.

Newer information supports the idea that not only does physical illness cause stress, but stress may bring on or worsen certain symptoms or diseases. When a person is scared (as in the example of the confrontation in the dark alley), his or her blood pressure and pulse increase. Many people experience diarrhea when confronted with the stress of an important test or presentation. Stress can also lead to common symptoms like headache, chest pain, or backache.

Failure to recognize the important role stress may play in the interaction between health and disease can lead to improper medical care.

What is the role of the primary care physician?

The primary care physician is well-suited to work with patients and help identify when stress may be playing an important role in an illness. The role of the primary care physician in this setting can be summarized as follows:

  • Forms a partnership with the patient to explore and solve problems.
  • Shares and reduces the burden of uncertainty and worry for the patient.
  • Helps distinguish when treatment is needed for stress.
  • Minimizes unnecessary medical testing.
  • Identifies and works with consultants with expertise in stress management.