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and Sources of Acute and Chronic Stress, the Impact of Stress
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Bibliographic Note
Because this page cannot legibly accommodate all the copyright notices, the Bibliographic
Note portion of the Preface constitutes an extension of the copyright notice.
Edited by Amy L. Sutton
Health Reference Series
Karen Bellenir, Managing Editor
David A. Cooke, MD, FACP, Medical Consultant
Elizabeth Collins, Research and Permissions Coordinator
Cherry Edwards, Permissions Assistant
EdIndex, Services for Publishers, Indexers
***
Omnigraphics, Inc.
Matthew P. Barbour, Senior Vice President
Kevin M. Hayes, Operations Manager
***
Peter E. Ruffner, Publisher
Copyright © 2011 Omnigraphics, Inc.
ISBN 978-0-7808-1148-5

Library of Congress Cataloging-in-Publication Data

Stress-related disorders sourcebook : basic consumer health information about stress
and stress-related disorders, including signs, symptoms, types, and sources of acute
and chronic stress, the impact of stress on the body, and mental health problems
associated with stress, such as depression, anxiety disorders, bipolar disorder,
obsessive-compulsive disorder, substance abuse, posttraumatic stress disorder, and
suicide; along with advice about getting help for stress-related disorders, managing
stress and coping with trauma, a glossary of stress-related terms, and a directory of
resources for additional help and information / edited by Amy L. Sutton. -- 3rd ed.
p. cm.
Includes bibliographical references and index.
Summary: "Provides basic consumer health information about the physical
and mental health effects of stress and trauma, related therapies and stress
management techniques, and coping tips for adults and children. Includes index,
glossary of related terms, and other resources"-- Provided by publisher.
ISBN 978-0-7808-1148-5 (hardcover : alk. paper) 1. Stress management--Popular
works. 2. Stress (Physiology)--Popular works. 3. Stress (Psychology)--Popular
works. I. Sutton, Amy L.
RA785.S78 2011
616.9'8--dc22
2011011839

Electronic or mechanical reproduction, including photography, recording, or any other infor-

mation storage and retrieval system for the purpose of resale is strictly prohibited without
permission in writing from the publisher.
The information in this publication was compiled from the sources cited and from other
sources considered reliable. While every possible effort has been made to ensure reliability,
the publisher will not assume liability for damages caused by inaccuracies in the data,
and makes no warranty, express or implied, on the accuracy of the information contained
herein.

This book is printed on acid-free paper meeting the ANSI Z39.48 Standard. The inﬁnity
symbol that appears above indicates that the paper in this book meets that standard.

Printed in the United States

Table of Contents
Visit www.healthreferenceseries.com to view A Contents Guide to the
Health Reference Series, a listing of more than 15,000 topics and the
volumes in which they are covered.

Preface ............................................................................................ xi

Part I: Introduction to Stress and Stress-Related

Disorders
Chapter 1—What Is Stress? ........................................................... 3
Chapter 2—Characteristics of Stress........................................... 11
Section 2.1—Signs and Symptoms of Stress ....... 12
Section 2.2—Types of Stress ................................ 16

Chapter 3—Stressful Life Events ................................................ 19

Chapter 4—Factors That Inﬂuence Response to Stress.............. 25
Section 4.1—Personality and Stress.................... 26
Section 4.2—Men and Women Cope with
Stress Differently ........................... 29
Section 4.3—Resistance Mechanisms
in Brain May Prevent
Stress-Related Illness..................... 31
Section 4.4—Chronic Stress and Loneliness
Affect Health ................................... 34
Section 4.5—Media Coverage Linked
to Stress .......................................... 37

v
Chapter 5—Childhood Stress ..................................................... 41
Chapter 6—Stress and Aging ..................................................... 45
Chapter 7—Stress in the United States .................................... 49

Part II: How Stress Affects the Body

Chapter 8—Alzheimer Disease .................................................. 67
Section 8.1—What Is Alzheimer Disease? ...... 68
Section 8.2—Alzheimer Disease and Stress ... 74

Chapter 9—Asthma .................................................................... 77

Section 9.1—What Is Asthma? ........................ 78
Section 9.2—Stress Increases Risk of
Asthma Exacerbations ............... 83

Chapter 10—Cancer and Stress ................................................... 85

Chapter 11—Diabetes and Stress ................................................ 89
Chapter 12—Erectile Dysfunction ............................................... 95
Chapter 13—Gastrointestinal Problems ................................... 103
Section 13.1—Irritable Bowel Syndrome ........ 104
Section 13.2—Peptic Ulcers ............................. 111
Section 13.3—Stress Gastritis......................... 116

Chapter 14—Headache and Its Link to Stress.......................... 121

Chapter 15—Heart and Cardiovascular Problems ................... 137
Section 15.1—Stress and Heart Disease ........ 138
Section 15.2—Stress and Blood Pressure ....... 139
Section 15.3—Stress and Cholesterol
Levels ........................................ 141
Section 15.4—Stress and Stroke ..................... 143

Chapter 16—Infertility and Stress ............................................ 145

Chapter 17—Multiple Sclerosis and Stress ............................... 149
Section 17.1—Does Multiple Sclerosis
Worsen Stress? ......................... 150
Section 17.2—Taming Stress in Multiple
Sclerosis .................................... 155

vi
Chapter 18—Obesity, Cortisol, and Stress ................................ 173
Chapter 19—Pain ........................................................................ 179
Section 19.1—Chronic Pain and
Stress-Related Disorders ......... 180
Section 19.2—Back Pain and Stress ............... 182

Chapter 20—Pregnancy and Stress ........................................... 185

Chapter 21—Skin Problems ....................................................... 191
Section 21.1—What Is Psoriasis? .................... 192
Section 21.2—The Psoriasis-Stress Link ........ 201
Section 21.3—Is Acne Linked to Stress? ......... 203

Chapter 22—Sleep ...................................................................... 205

Section 22.1—Stress, Behavior, and Sleep ...... 206
Section 22.2—Insomnia ................................... 209

Chapter 23—Teeth Grinding (Bruxism) .................................... 219

Part III: How Stress Affects Mental Health

Chapter 24—Depression ............................................................. 225
Section 24.1—What Is Depression? ................ 226
Section 24.2—Depressed Patients
Experience Inﬂammation
under Stress ............................. 229
Section 24.3—Stress Indicators Detected
in Depression-Prone Women’s
Sweat ........................................ 231

Chapter 25—Anxiety Disorders ................................................. 233

Chapter 26—Bipolar Disorder.................................................... 241
Chapter 27—Disordered Eating and Stress .............................. 249
Section 27.1—Emotional Eating ..................... 250
Section 27.2—Eating Disorders Linked to
Feelings of Extreme Distress ... 254
Section 27.3—Binge Eating Disorder ............. 260
Section 27.4—Nocturnal Sleep-Related
Eating Disorder ........................ 264

vii
Chapter 28—Obsessive-Compulsive Disorder ........................... 269
Chapter 29—Substance Abuse, Addiction, and Stress .............. 273
Section 29.1—Stress and Substance Abuse .... 274
Section 29.2—Tobacco and Stress ................... 278
Section 29.3—Alcohol and Stress .................... 279
Section 29.4—Drugs, Stress, and Trauma ...... 289

Chapter 30—Bereavement, Mourning, and Grief ..................... 297

Chapter 31—Common Reactions after Trauma ........................ 309
Chapter 32—Types of Stress-Related Disorders That
Develop after Trauma........................................... 313
Section 32.1—Dissociative Disorders.............. 314
Section 32.2—Acute Stress Disorder .............. 316
Section 32.3—Posttraumatic Stress
Disorder (PTSD) ....................... 318

Chapter 33—Relationships and Traumatic Stress ................... 329

Chapter 34—Traumatic Stress in Children and Teens............. 333
Chapter 35—Returning from the War Zone: PTSD in
Military Personnel ................................................ 339
Chapter 36—Recent Research on PTSD .................................... 353

Part IV: Treating Stress-Related Disorders

Chapter 37—Signs You or a Family Member Need
Help for Stress ...................................................... 365
Chapter 38—Finding and Choosing a Therapist....................... 375
Chapter 39—Psychotherapies for Stress-Related Disorders .... 381
Chapter 40—Medications for Stress-Related Disorders ........... 389
Chapter 41—Complementary and Alternative Medicine
Therapies............................................................... 411
Section 41.1—Overview of Stress
Management Strategies ........... 412
Section 41.2—Acupuncture ............................. 417

viii
Section 41.3—Herbal Supplements May
Improve Stress Symptoms ....... 418
Section 41.4—Massage Therapy ..................... 421
Section 41.5—Meditation ................................ 426
Section 41.6—Spirituality May Alleviate
Distress ..................................... 431
Section 41.7—Yoga ........................................... 435

Chapter 42—Treating Depression ............................................. 439

Chapter 43—Treating Anxiety Disorders .................................. 443
Chapter 44—Treating Bipolar Disorder .................................... 449
Chapter 45—Coping with Traumatic Stress Reactions ............ 457
Chapter 46—PTSD Treatment ................................................... 467
Chapter 47—Helping a Family Member with PTSD ................ 475
Chapter 48—Preventing Suicide ................................................ 481

Part V: Stress Management

Chapter 49—The Basics of Preventing and
Managing Stress ................................................... 489
Chapter 50—Developing Resilience: The Most Important
Defense against Stress ......................................... 493
Chapter 51—How to Say No: Asserting Yourself Can
Reduce Stress ........................................................ 501
Chapter 52—Healthy Habits to Combat Stress ........................ 507
Section 52.1—Your Guide to Healthy Sleep ... 508
Section 52.2—Exercise Can Help Control
Stress ........................................ 521
Section 52.3—Nutrition and Stress ................ 522
Section 52.4—Stress Levels Rise in
Response to Caffeine ................ 525

Chapter 53—Stressful Situations: Tips for Coping ................... 527

Section 53.1—Aggressive Driving ................... 528
Section 53.2—Caregiver Stress ....................... 530

ix
Section 53.3—Economic Hardship .................. 538
Section 53.4—Holiday Stress .......................... 541
Section 53.5—Work Stress............................... 546

Chapter 54—Other Stress Management Strategies ................. 553

Section 54.1—Humor as Stress Relief ............ 554
Section 54.2—Pet Ownership Reduces
Stress ........................................ 555
Section 54.3—Social Support: Who Can
Give It and How to Get It ........ 558

Chapter 55—Stress Management for Children, Teens,

and Families .......................................................... 561
Section 55.1—Stress Management Tips for
Children and Teens .................. 562
Section 55.2—Helping Kids Cope in Times
of Crisis ..................................... 566
Section 55.3—Nature Helps Kids Deal
with Stress ................................ 568
Section 55.4—Combating Parental Stress ...... 570

Chapter 56—Managing Stress in Later Life ............................. 573

Part VI: Additional Help and Information

Chapter 57—Glossary of Terms Related to Stress and
Stress-Related Disorders ...................................... 581
Chapter 58—Directory of Organizations for People with
Stress-Related Disorders ...................................... 587
Index ........................................................................................... 599

x
Preface

About This Book

Nearly half of U.S. adults report their stress has increased in the
last year. Work and money lead the list of major stressors, followed
closely by concerns about the economy and family responsibilities.
Stress takes its toll on the body by eroding sleep quality and mental
focus, leaving its victims impatient, irritable, fatigued, and prone to
overeating and substance abuse. Prolonged stress adversely affects
immune system function, worsening conditions such as chronic pain
disorders, diabetes, and heart problems. Mental health disorders, in-
cluding depression, anxiety, and posttraumatic stress disorder, are also
linked to serious problems coping with stress. As stress levels in adults
rise, so do those in children and adolescents who struggle to cope with
worries about family and school.
Stress-Related Disorders Sourcebook, Third Edition provides up-
dated information about the origins and types of stress and describes
physical and mental health disorders that may develop during and
after stressful situations. Readers will learn about how stress worsens
asthma, digestive disorders, infertility, and chronic pain. The Source-
book also discusses how stress contributes to mental health problems,
including depression, anxiety disorders, posttraumatic stress disorder,
and addiction to tobacco, alcohol, and drugs. Information about trauma,
loss, and grief is presented, along with suggestions for managing stress-
ful situations, such as aggressive driving, caregiver stress, economic
hardship, return from active military duty, and occupational stress.

xi
Tips on helping children and teens cope with stress are also offered,
along with a glossary of related terms and a directory of resources.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad
areas of interest. Chapters are devoted to single topics within a part.
Part I: Introduction to Stress and Stress-Related Disorders identifies
signs and symptoms of acute, chronic, and posttraumatic stress and
discusses life events and risk factors that increase vulnerability to
developing stress-related disorders. Facts about the impact of finan-
cial, emotional, and physical stress on the American population are
also included.
Part II: How Stress Affects the Body provides information about health
conditions exacerbated by stress. These include asthma, diabetes, gas-
trointestinal problems, headache, multiple sclerosis, obesity, sleep dis-
orders, and chronic pain disorders.
Part III: How Stress Affects Mental Health discusses how stress erodes
emotional well-being and contributes to the development of mental
health disorders, such as depression, anxiety disorders, bipolar disor-
der, disordered eating, obsessive-compulsive disorder, and substance
abuse and addiction. Trauma survivors and their families will also
find information about common reactions after trauma and types of
stress-related disorders that develop after exposure to violence, disas-
ter, assault, or war.
Part IV: Treating Stress-Related Disorders offers information about
treatments for stress-related disorders, including psychological thera-
pies, medications, and complementary and alternative medicine. For
people coping with a loved one’s stress-related responses, this part
offers tips on helping someone with posttraumatic stress disorder and
recognizing when someone needs help from mental health and other
medical professionals.
Part V: Stress Management identifies strategies for combating stress
in everyday life. People coping with emotional and physical reactions
to stress will find suggestions on healthy habits that alleviate stress
and tips for coping with stressful situations at home, at work, and on
the road. Information about developing resilience is also included,
along with tips on stress management for children, teens, families,
and older adults.

xii
Part VI: Additional Help and Information provides a glossary of impor-
tant terms related to stress and stress-related disorders. A directory
of organizations that provide health information about stress-related
disorders is also included.

Bibliographic Note
This volume contains documents and excerpts from publications
issued by the following U.S. government agencies: Centers for Dis-
ease Control and Prevention (CDC); Drug Enforcement Administra-
tion (DEA); Federal Bureau of Investigation (FBI); National Cancer
Institute (NCI); National Center for Complementary and Alternative
Medicine (NCCAM); National Center for Posttraumatic Stress Disor-
der (NCPTSD); National Health Information Center (NHIC); National
Heart, Lung, and Blood Institute (NHLBI); National Highway Traf-
fic Safety Administration (NHTSA); National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS); National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK); National
Institute of Mental Health (NIMH); National Institute of Neurologi-
cal Disorders and Stroke (NINDS); National Institute on Aging (NIA);
National Institute on Alcohol Abuse and Alcoholism (NIAAA); National
Institute on Drug Abuse (NIDA); National Institutes of Health (NIH);
Office of the Surgeon General (OGS); Office on Women’s Health (OWH);
Substance Abuse and Mental Health Services Administration (SAM-
HSA); U.S. Army Center for Health Promotion and Preventive Medicine
(USACHPPM); and the U.S. Food and Drug Administration (FDA).
In addition, this volume contains copyrighted documents from the
following organizations: A.D.A.M., Inc.; American Heart Association;
American Institute of Stress; American Psychological Association;
Centre for Clinical Interventions; Cornell Chronicle/Cornell Univer-
sity News Service; Delta Society; Emory University; Franklin Insti-
tute; Iowa State University Extension; March of Dimes Birth Defects
Foundation; Meals Matter; Mendosa.com; National Alliance on Men-
tal Illness; National Multiple Sclerosis Society; National Psoriasis
Foundation; Nemours Foundation; Pennsylvania State University;
ProjectAware; Psych Central; Regents of the University of Michigan;
Remedy Health Media; Talk About Sleep; University of California at
Irvine; University of California–San Francisco News Office; University
of Pennsylvania Health System; and Wake Forest University Baptist
Medical Center.
Full citation information is provided on the first page of each chap-
ter or section. Every effort has been made to secure all necessary

xiii
rights to reprint the copyrighted material. If any omissions have been
made, please contact Omnigraphics to make corrections for future
editions.

Acknowledgements
Thanks go to the many organizations, agencies, and individuals
who have contributed materials for this Sourcebook and to medical
consultant Dr. David Cooke and prepress service provider WhimsyInk.
Special thanks go to managing editor Karen Bellenir and research and
permissions coordinator Liz Collins for their help and support.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical
information for patients, families, caregivers, and the general public.
Each volume takes a particular topic and provides comprehensive cov-
erage. This is especially important for people who may be dealing with
a newly diagnosed disease or a chronic disorder in themselves or in a
family member. People looking for preventive guidance, information
about disease warning signs, medical statistics, and risk factors for
health problems will also ﬁnd answers to their questions in the Health
Reference Series. The Series, however, is not intended to serve as a tool
for diagnosing illness, in prescribing treatments, or as a substitute for
the physician/patient relationship. All people concerned about medical
symptoms or the possibility of disease are encouraged to seek profes-
sional care from an appropriate health care provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary
as an authority for questions related to the spelling of medical terms
and the Chicago Manual of Style for questions related to grammati-
cal structures, punctuation, and other editorial concerns. Consistent
adherence is not always possible, however, because the individual
volumes within the Series include many documents from a wide va-
riety of different producers and copyright holders, and the editor’s
primary goal is to present material from each source as accurately
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ducer. This sometimes means that information in different chapters
or sections may follow other guidelines and alternate spelling authori-
ties. For example, occasionally a copyright holder may require that

xiv
eponymous terms be shown in possessive forms (Crohn’s disease vs.
Crohn disease) or that British spelling norms be retained (leukaemia
vs. leukemia).

Locating Information within the Health Reference Series

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sheets, research reports, in-depth discussions, and other material con-
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A Contents Guide to the Health Reference Series was developed to
direct readers to the speciﬁc volumes that address their concerns. It
presents an extensive list of diseases, treatments, and other topics of
general interest compiled from the Tables of Contents and major index
headings. To access A Contents Guide to the Health Reference Series,
visit www.healthreferenceseries.com.

Medical Consultant
Medical consultation services are provided to the Health Reference
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Our Advisory Board

We would like to thank the following board members for providing
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s $R ,YNDA "AKER !SSOCIATE 0ROFESSOR OF ,IBRARY AND
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xv
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Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the ﬁrst
edition of Cancer Sourcebook published in 1989. Since then, the Series
has been enthusiastically received by librarians and in the medical
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health information for the layperson the editorial staff at Omnigraphics
felt it was necessary to implement a policy of updating volumes when
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it is the purpose of the Health Reference Series to stay current with
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Health Reference Series
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E-mail: [email protected]

xvi
Part One

Introduction to Stress and

Stress-Related Disorders
Chapter 1

What Is Stress?

Stress is the emotional and physical strain caused by the response

to pressure from the outside world. Unfortunately, there is not a uni-
versally agreed upon definition of stress, and individuals react differ-
ently to stress. What is stressful for one person may be pleasurable
or have little effect on others. Stress is not necessarily bad; in small
doses, it can help people perform under pressure and motivate them
to do their best. But, beyond a certain point, stress stops being helpful
and starts causing damage to health, mood, productivity, relationships,
and quality of life.
Stress is a normal physical response to events that make a per-
son feel threatened or upset. When danger is sensed—whether it is
real or imagined—the body’s defenses kick into high gear in a rapid,
automatic process known as the fight-or-flight reaction, or the stress
response. The brain signals the release of stress hormones. These
chemical substances trigger a series of responses that gives the body
extra energy: Blood sugar levels rise, the heartbeat speeds up, and
blood pressure increases. The muscles tense for action. The blood
supply is diverted away from the core to the extremities to help the
body deal with the situation at hand. The stress response is the body’s
way of protecting itself.

From “Stress and Stress Management,” by the Substance Abuse and Mental
Health Services Administration (SAMHSA, mentalhealth.samhsa.gov), part of
the U.S. Department of Health and Human Services, 2009.

3
Stress-Related Disorders Sourcebook, Third Edition

Are There Different Types of Stress?

Stress management can be complicated and confusing because there
are different types of stress: Acute stress, episodic acute stress, chronic
stress, and posttraumatic stress, each with its own characteristics,
symptoms, duration, and treatment approaches.
Acute stress is the most common form of stress. It comes from de-
mands and pressures of the recent past and anticipated demands and
pressures of the near future. Because it is short-term, acute stress does
not have enough time to do the extensive damage associated with long-
term stress. Acute stress can crop up in anyone’s life, and it is highly
treatable and manageable.
Those who suffer acute stress frequently are dealing with episodic
acute stress. It is common for people with episodic acute stress to be
over-aroused, short-tempered, irritable, anxious, and tense. Interper-
sonal relationships deteriorate rapidly when others respond with real
hostility. Work becomes a very stressful place for them. Often, lifestyle
and personality issues are so ingrained and habitual with these indi-
viduals that they see nothing wrong with the way they conduct their
lives. They blame their woes on other people and external events.
Frequently, they see their lifestyles, patterns of interacting with oth-
ers, and ways of perceiving the world as part and parcel of who and
what they are. Without proper coping strategies, episodic acute stress
develops into chronic stress.
Chronic stress is the grinding stress that wears people away day
after day, year after year. It destroys bodies, minds, and lives. It is the
stress of unrelenting demands and pressures for seemingly intermi-
nable periods of time. The worst aspect of chronic stress is that people
get used to it. They forget it is there. People are immediately aware of
acute stress because it is new. Chronic stress is ignored because it is
familiar and almost comfortable.
Posttraumatic stress disorder (PTSD) stems from traumatic ex-
periences that become internalized and remain forever painful and
present. Individuals experiencing PTSD could exhibit signs of hy-
pervigilance (an easily triggered startle response). People with an
exaggerated startle response are easily startled by any number of
things (e.g., loud noises, doors slamming, shouting). They usually
feel tense or on edge. Along with hypervigilance, people experiencing
PTSD symptoms also could be dealing with avoidance issues includ-
ing staying away from places, events, or objects that are reminders
of the experience; feeling emotionally numb; feeling strong guilt,
depression, or worry; losing interest in activities that were enjoyable

4
What Is Stress?

in the past; and having trouble remembering the dangerous event.

People experiencing PTSD symptoms wear down to breaking points
because physical and mental resources are depleted through long-
term attrition. The symptoms of posttraumatic stress are difﬁcult
to treat and may require the help of a doctor or mental health pro-
fessional.

What Are Some Common Myths Surrounding Stress?

[Editor’s Note: The text under this heading is adapted from the
American Psychological Association, 2008.]

Myth: Stress is the same for everyone.

Stress is different for everyone. What is stressful for one person
may or may not be stressful for another. Each person may respond to
stress in an entirely different way.

Myth: Stress is always bad.

According to this view, zero stress makes us happy and healthy.
This is wrong—stress is a normal part of life. Stress can be the kiss
of death or the spice of life. The issue is how to manage it. Managed
stress makes people productive and happy. Mismanaged stress hurts
and even kills.

Myth: Stress is everywhere, so nothing can be done about it.

Not so. Life can be planned so that stress does not become over-
whelming.

Myth: The most popular techniques for reducing stress are

the best ones.
No universally effective stress reduction techniques exist, because
each individual reacts differently.

Myth: No symptoms, No stress.

Absence of symptoms does not mean the absence of stress. In fact,
camouﬂaging symptoms with medication may deprive a person of the
signals needed for reducing the strain on physiological and psychologi-
cal systems.

5
Stress-Related Disorders Sourcebook, Third Edition

Myth: Only major symptoms of stress require attention.

This myth assumes that minor symptoms, such as headaches or
stomach acid, may be safely ignored. Minor symptoms of stress are
the early warnings that life is getting out of hand and stress needs to
be better managed.

Common Stressors
[Editor’s Note: The text under this heading includes data from the
American Psychological Association, 2008.]
s &INANCIAL ISSUES PERCENT OF !MERICANS WORRY ABOUT THIS TOPIC
s 7ORK AND JOB STABILITY PERCENT OF !MERICANS WORRY ABOUT THIS
topic.
s 4HE NATIONS ECONOMY PERCENT OF !MERICANS WORRY ABOUT THIS
topic.
s (EALTH CONCERNS FAMILY AND PERSONAL PERCENT OF !MERICANS
worry about this topic.
s 2ELATIONSHIPS PERCENT OF !MERICANS WORRY ABOUT THIS TOPIC
s 0ERSONAL SAFETY PERCENT OF !MERICANS WORRY ABOUT THIS TOPIC
s ,OSS PERCENT OF !MERICANS WORRY ABOUT THIS TOPIC

How Does Stress Affect People?

Stress is taking a toll on people—contributing to health problems,
poor relationships, and lost productivity at work, according to a nation-
al survey released by the American Psychological Association (APA).
Twenty-eight percent of Americans say that they are managing their
stress extremely well. However, many people report experiencing phys-
ICAL SYMPTOMS PERCENT AND PSYCHOLOGICAL SYMPTOMS PERCENT
related to stress. While Americans deal with high levels of stress on a
daily basis, the health consequences are most serious when that stress
is poorly managed. The body does not distinguish between physical
and psychological threats. Everyone reacts differently to stress, and
each body sends out a different set of red ﬂags.

Is Stress Experienced Differently by Genders or

Generations?
The APA reported that nearly half of Americans state that their
STRESS LEVELS HAVE INCREASED SINCE .OVEMBER WITH AS MANY AS

6
What Is Stress?

PERCENT RATING THEIR AVERAGE STRESS LEVELS AS EXTREME OR ON

A POINT SCALE WHERE MEANS hA GREAT DEAL OF STRESSv !T THE SAME
time, economic conditions take a physical and emotional toll on people
nationwide. Compared with men, more women say they are stressed
about the following issues:
s -ONEY PERCENT VS PERCENT
s 4HE ECONOMY PERCENT VS PERCENT
s (OUSING COSTS PERCENT VS PERCENT
s (EALTH PROBLEMS AFFECTING THEIR FAMILIES PERCENT VS PER-
cent)

Across the board, women are reporting higher levels of stress, are
more likely than men to cite various stressors, and report more physi-
cal and emotional symptoms as a result of stress, suggesting that stress
is having a signiﬁcant impact on women.
In reports released by the APA, older adults report having less
stress and managing stress better than younger adults. However, the
ﬁnancial crisis is having a greater impact on older generations, and
this impact is leading to more stress at work. Many older adults are
waiting to retire or coming out of retirement and joining the workforce
to make ends meet.

Does Stress Look Different across Cultures?

Stress is common to all people regardless of ethnicity. However,
sources of stress vary among cultural groups. All cultural groups are
reporting increased stress about money and work. However, as a result
of cultural norms, many ethnic groups are having difﬁculty asking for
help regarding coping skills. When it comes to managing stress, the
APA reports that several cultural groups say they are doing enough
to manage their stress; however, groups do not report that they are
managing their stress well. It is important to maintain a sense of iden-
tity and social support when feeling overwhelmed and stressed. This
includes embracing cultural background when developing a personal
strategy for dealing with stress.

What Are the Warning Signs of Stress?

It is important to learn how to recognize when stress levels are dan-
gerously high. The most dangerous thing about stress is how easily it
can get out of control. Many factors can cause it, but common triggers

Stress-Related Disorders Sourcebook, Third Edition

tend to be the pressures of work, relationships, money, or family prob-

lems, or merely the fact that life suddenly seems to be a constant tough
battle. One of the important aids for combating and dealing with stress
is to ﬁrst recognize it. Stress affects minds, bodies, and behaviors in
many ways, and everyone experiences stress differently. A body’s stress
warning signs alert a person that something is not right, much like
the glowing “check engine” light on a car’s dashboard.

Warning Signs of Stress

[Editor’s Note: The text under this heading is adapted from Mental
(EALTH !MERICA =

Cognitive Signs
s -EMORY PROBLEMS
s )NABILITY TO CONCENTRATE
s 0OOR JUDGMENT
s .EGATIVITY
s !NXIOUS OR RACING THOUGHTS
s #ONSTANT WORRYING

Emotional Signs
s -OODINESS
s )RRITABILITY OR SHORT TEMPER
s !GITATION INABILITY TO RELAX
s &EELING OVERWHELMED
s 3ENSE OF LONELINESS AND ISOLATION
s $EPRESSION OR GENERAL UNHAPPINESS

Physical Signs
s !CHES AND PAINS
s (EADACHES
s $IARRHEA OR CONSTIPATION
s .AUSEA DIZZINESS
s #HEST PAIN RAPID HEARTBEAT

8
What Is Stress?

s ,OSS OF SEX DRIVE

s &REQUENT COLDS

Behavioral Signs
s %ATING MORE OR LESS
s 3LEEPING TOO MUCH OR TOO LITTLE
s )SOLATING FROM OTHERS
s 0ROCRASTINATING OR NEGLECTING RESPONSIBILITIES
s 5SING ALCOHOL CIGARETTES OR DRUGS TO RELAX
s .ERVOUS HABITS EG NAIL BITING PACING

Can Stress Be Prevented?

Stressful situations in life cannot be prevented. However, they can
be prepared for in a way that allows a positive response. This is done
BY BUILDING AND FOSTERING RESILIENCE IN DIFFERENT AREAS OF LIFE 2ESILIENCE
implies that after an event, a person or community may not only be
able to cope and recover, but also change to reﬂect different priorities
arising from the experience and prepare for the next stressful situa-
tion. Fostering resilience, or the ability to bounce back from a stressful
situation, builds a proactive mechanism to manage stress. Developing
a greater level of resilience will not prevent stressful conditions from
happening, but it can reduce the level of disruption a stressor has and
the time it takes to recover.

How Can Stress Be Managed?

Stress can be dealt with proactively or reactively. It can be dealt
with proactively by building personal resilience to prepare for stressful
circumstances, while learning how to recognize signs and symptoms
of stress. It can be dealt with reactively by utilizing coping strategies
useful for the individual. The key is not to avoid stress altogether, but
to manage the stress in such a way that the negative consequences of
stress are avoided. There are many positive ways to manage stress.
4HE BEST DEFENSE AGAINST STRESS IS BUILDING RESILIENCE 2ESILIENCE
refers to the ability of an individual, family, organization, or commu-
nity to cope with adversity and adapt to challenges or change. It is a
process of drawing on beliefs, behaviors, skills, and attitudes to move
beyond stress, trauma, or tragedy. While building defenses through

9
Stress-Related Disorders Sourcebook, Third Edition

resilience, it also is important to be ready to deal with stress if the

internal resilience reservoir is not enough.
Managing stress can include simple ideas, such as recognizing signs
of stress, learning breathing techniques, and engaging in spiritual com-
munities, and more advanced interventions with professionals, such as
seeking the help of a mental health professional and learning stress
inoculation techniques. The goal of stress inoculation is to develop a
procedure that will almost instantaneously put a person in a calm
state. This is not necessarily a completely relaxed condition since many
demanding situations will not allow that. The idea, however, is to be
able to step back and look at problematic circumstances in a realistic
light without feeling too hassled.
Uncontrolled stress can lead to many problems. Simple headaches,
tight muscles, problems with sleeping, or a bad mood can be a prelude
to much more severe symptoms. There are many healthy ways to man-
age and cope with stress, but they all require change: Either changing
the situation or changing reactions to the situation. If stress is affecting
a person’s ability to work or ﬁnd pleasure in life, help should be sought
from a doctor, mental health provider, or other professional.

References
!MERICAN 0SYCHOLOGICAL !SSOCIATION 3TRESS IN !MERICA 2E-
trieved March 23, 2009, from http://apahelpcenter.mediaroom.com/
lLEPHP3TRESS IN !MERICA 2%0/24 &).!,DOC
!MERICAN )NSTITUTE OF 3TRESS ND %FFECTS OF STRESS 2ETRIEVED -ARCH
FROM HTTPWWWSTRESSORGTOPIC EFFECTSHTM!)3ADF
DDBBBEEA
-ENTAL (EALTH !MERICA ND 3TRESS +NOW THE SIGNS 2ETRIEVED -ARCH
23, 2009, from http://www.mentalhealthamerica.net/go/mental-health
-month/stress-know-the-signs

Chapter 2

Characteristics of Stress

Chapter Contents
3ECTION 3IGNS AND 3YMPTOMS OF 3TRESS ...............................
Section 2.2—Types of Stress ........................................................

Stress-Related Disorders Sourcebook, Third Edition

Section 2.1

Signs and Symptoms of Stress

“The Effects of Stress,” © American Institute of Stress (www.stress.org).
2EPRINTED WITH PERMISSION 4HIS DOCUMENT IS UNDATED !DDITIONAL INFOR-
mation is available at Current and Past Stress Scoops, Current and Past
.EWSLETTERS AND ELSEWHERE ON WWWSTRESSORG 2EVIEWED BY $AVID ! #OOKE
-$ &!#0 .OVEMBER

Stress is difﬁcult for scientists to deﬁne because it is a highly subjec-

tive phenomenon that differs for each of us. Things that are distressful
for some individuals can be pleasurable for others. We also respond
to stress differently. Some people blush, some eat more while others
grow pale or eat less. There are numerous physical as well as emotional
responses as illustrated by the following list of some 50 common signs
and symptoms of stress.
&REQUENT HEADACHES JAW CLENCHING OR PAIN
2. Gritting, grinding teeth
3. Stuttering or stammering
4. Tremors, trembling of lips, hands
5. Neck ache, back pain, muscle spasms
6. Lightheadedness, faintness, dizziness
2INGING BUZZING OR POPPING SOUNDS
8. Frequent blushing, sweating
9. Cold or sweaty hands, feet
$RY MOUTH PROBLEMS SWALLOWING
&REQUENT COLDS INFECTIONS HERPES SORES
2ASHES ITCHING HIVES hGOOSE BUMPSv
5NEXPLAINED OR FREQUENT hALLERGYv ATTACKS
(EARTBURN STOMACH PAIN NAUSEA
%XCESS BELCHING mATULENCE

Characteristics of Stress

#ONSTIPATION DIARRHEA

$IFlCULTY BREATHING SIGHING
3UDDEN ATTACKS OF PANIC
#HEST PAIN PALPITATIONS
20. Frequent urination
0OOR SEXUAL DESIRE OR PERFORMANCE
22. Excess anxiety, worry, guilt, nervousness
23. Increased anger, frustration, hostility
24. Depression, frequent or wild mood swings
25. Increased or decreased appetite
26. Insomnia, nightmares, disturbing dreams
$IFlCULTY CONCENTRATING RACING THOUGHTS
28. Trouble learning new information
29. Forgetfulness, disorganization, confusion
30. Difﬁculty in making decisions
&EELING OVERLOADED OR OVERWHELMED
32. Frequent crying spells or suicidal thoughts
33. Feelings of loneliness or worthlessness
34. Little interest in appearance, punctuality
35. Nervous habits, ﬁdgeting, feet tapping
36. Increased frustration, irritability, edginess
/VERREACTION TO PETTY ANNOYANCES
38. Increased number of minor accidents
39. Obsessive or compulsive behavior
2EDUCED WORK EFlCIENCY OR PRODUCTIVITY
,IES OR EXCUSES TO COVER UP POOR WORK
2APID OR MUMBLED SPEECH
43. Excessive defensiveness or suspiciousness
44. Problems in communication, sharing
45. Social withdrawal and isolation

Stress-Related Disorders Sourcebook, Third Edition

46. Constant tiredness, weakness, fatigue

&REQUENT USE OF OVER THE COUNTER DRUGS
48. Weight gain or loss without diet
49. Increased smoking, alcohol, or drug use
50. Excessive gambling or impulse buying

The Effects of Stress

Physical or mental stresses may cause
Brain:
physical illness as well as mental or emo-
Stress triggers mental and emo-
tional problems. Here are the parts of the
tional problems such as insomnia,
body most affected by stress:
headaches, personality changes,
anxiety, and depression.
Hair:
High stress levels may cause
excessive hair loss and some Mouth:
forms of baldness. Mouth ulcers and exces-
sive dryness are often
symptoms of stress.
Heart:
Muscles: Cardiovascular disease and
Spasmodic pains in the hypertension are linked to
neck and shoulders, muscu- accumulated stress.
loskeletal aches, lower back
pain, and various minor Lungs:
muscular twitches and High levels of men-
nervous tics are more tal or emotional
noticeable under stress. stress adversely
affect individuals
with asthmatic
conditions.

Digestive tract:
Stress can cause or aggravate
disease of the digestive tract Reproductive organs:
including gastritis, stomach and Stress affects the reproductive
duodenal ulcers, ulcerative colitis, system causing menstrual dis-
and irritable colon. orders and recurrent vaginal
infections in women and impo-
tence and premature ejacula-
tion in men.

Skin:
Some individuals react to stress
with outbreaks of skin problems
such as eczema and psoriasis.

Figure 2.1. Parts of the body most affected by stress.

Characteristics of Stress

As demonstrated in the preceding list, stress can have wide ranging

effects on emotions, mood, and behavior. Equally important but often
less appreciated are effects on various systems, organs, and tissues all
OVER THE BODY AS ILLUSTRATED BY &IGURE
There are numerous emotional and physical disorders that have
been linked to stress including depression, anxiety, heart attacks,
stroke, hypertension, immune system disturbances that increase sus-
ceptibility to infections, a host of viral linked disorders ranging from
the common cold and herpes to AIDS [acquired immunodeﬁciency
syndrome] and certain cancers, as well as autoimmune diseases like
rheumatoid arthritis and multiple sclerosis. In addition stress can have
direct effects on the skin (rashes, hives, atopic dermatitis, the gastro-
INTESTINAL SYSTEM '%2$ ;GASTROESOPHAGEAL REmUX DISEASE= PEPTIC
ulcer, irritable bowel syndrome, ulcerative colitis) and can contribute
to insomnia and degenerative neurological disorders like Parkinson’s
disease. In fact, it’s hard to think of any disease in which stress cannot
play an aggravating role or any part of the body that is not affected.
This list will undoubtedly grow as the extensive ramiﬁcations of stress
are increasingly being appreciated.

Stress-Related Disorders Sourcebook, Third Edition

Section 2.2

Types of Stress
Excerpted from “The Effects of Childhood Stress on
Health across the Lifespan,” by the Centers for Disease Control
and Prevention (CDC, www.cdc.gov), 2008.

Stress is an inevitable part of life. Human beings experience stress

early, even before they are born. A certain amount of stress is normal
and necessary for survival. Stress helps children develop the skills they
need to cope with and adapt to new and potentially threatening situ-
ations throughout life. Support from parents and/or other concerned
caregivers is necessary for children to learn how to respond to stress
in a physically and emotionally healthy manner.
The beneﬁcial aspects of stress diminish when it is severe enough to
overwhelm a child’s ability to cope effectively. Intensive and prolonged
stress can lead to a variety of short- and long-term negative health ef-
fects. It can disrupt early brain development and compromise function-
ing of the nervous and immune systems. In addition, childhood stress
can lead to health problems later in life including alcoholism, depression,
eating disorders, heart disease, cancer, and other chronic diseases.

Positive Stress
Positive stress results from adverse experiences that are short-
lived. Children may encounter positive stress when they attend a new
daycare, get a shot, meet new people, or have a toy taken away from
them. This type of stress causes minor physiological changes including
an increase in heart rate and changes in hormone levels. With the sup-
port of caring adults, children can learn how to manage and overcome
positive stress. This type of stress is considered normal and coping
with it is an important part of the development process.

Tolerable Stress
Tolerable stress refers to adverse experiences that are more intense
but still relatively short-lived. Examples include the death of a loved

Characteristics of Stress

one, a natural disaster, a frightening accident, and family disruptions

such as separation or divorce. If a child has the support of a caring
adult, tolerable stress can usually be overcome. In many cases, toler-
able stress can become positive stress and beneﬁt the child develop-
mentally. However, if the child lacks adequate support, tolerable stress
can become toxic and lead to long-term negative health effects.

Toxic Stress
Toxic stress results from intense adverse experiences that may be
sustained over a long period of time—weeks, months, or even years. An
example of toxic stress is child maltreatment, which includes abuse and
neglect. Children are unable to effectively manage this type of stress
by themselves. As a result, the stress response system gets activated
for a prolonged amount of time. This can lead to permanent changes in
the development of the brain. The negative effects of toxic stress can
be lessened with the support of caring adults. Appropriate support and
intervention can help in returning the stress response system back to
its normal baseline.

Chapter 3

Stressful Life Events

The most common psychological and social stressors in adult life

include the breakup of intimate romantic relationships, death of a
family member or friend, economic hardships, racism and discrimi-
nation, poor physical health, and accidental and intentional assaults
on physical safety. Although some stressors are so powerful that they
would evoke significant emotional distress in most otherwise mentally
healthy people, the majority of stressful life events do not invariably
TRIGGER MENTAL DISORDERS 2ATHER THEY ARE MORE LIKELY TO SPAWN MEN-
tal disorders in people who are vulnerable biologically, socially, and/
or psychologically. Understanding variability among individuals to a
stressful life event is a major challenge to research. Groups at greater
statistical risk include women, young and unmarried people, African
Americans, and individuals with lower socioeconomic status.
Divorce is a common example. Approximately one half of all mar-
riages now end in divorce, and about 30 to 40 percent of those under-
going divorce report a significant increase in symptoms of depression
and anxiety. Vulnerability to depression and anxiety is greater among
those with a personal history of mental disorders earlier in life and is
lessened by strong social support. For many, divorce conveys additional
economic adversities and the stress of single parenting. Single mothers
face twice the risk of depression as do married mothers.
%XCERPTED FROM h-ENTAL (EALTH ! 2EPORT OF THE 3URGEON 'ENERALn#HAPTER
4,” by the Office of the Surgeon General (www.surgeongeneral.gov), part of the
53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES 2EVIEWED BY $AVID !
#OOKE -$ &!#0 .OVEMBER

Stress-Related Disorders Sourcebook, Third Edition

The death of a child or spouse during early or mid-adult life is

much less common than divorce but generally is of greater potency in
PROVOKING EMOTIONAL DISTRESS 2ATES OF DIAGNOSABLE MENTAL DISORDERS
during periods of grief are attenuated by the convention not to diagnose
depression during the ﬁrst 2 months of bereavement. In fact, people
are generally unlikely to seek professional treatment during bereave-
ment unless the severity of the emotional and behavioral disturbance
is incapacitating.
A majority of Americans never will confront the stress of surviving
a severe, life-threatening accident or physical assault (e.g., mugging,
robbery, rape); however, some segments of the population, particularly
urban youths and young adults, have exposure rates as high as 25 to
30 percent. Life-threatening trauma frequently provokes emotional
and behavioral reactions that jeopardize mental health. In the most
fully developed form, this syndrome is called posttraumatic stress
disorder. Women are twice as likely as men to develop posttraumatic
stress disorder following exposure to life-threatening trauma.
More familiar to many Americans is the chronic strain that poor
physical health and relationship problems place on day-to-day well-
BEING 2ELATIONSHIP PROBLEMS INCLUDE UNSATISFACTORY INTIMATE RELATION-
ships; conﬂicted relationships with parents, siblings, and children; and
“falling-out” with coworkers, friends, and neighbors. In mid-adult life, the
stress of caretaking for elderly parents also becomes more common.
2ELATIONSHIP PROBLEMS AT LEAST DOUBLE THE RISK OF DEVELOPING A
mental disorder, although they are less immediately threatening or
potentially cataclysmic than divorce or the death of a spouse or child.
Finally, cumulative adversity appears to be more potent than stressful
events in isolation as a predictor of psychological distress and mental
disorders.

Past Trauma and Child Sexual Abuse

Severe trauma in childhood may have enduring effects into adult-
hood. Past trauma includes sexual and physical abuse, and parental
death, divorce, psychopathology, and substance abuse.
Child sexual abuse is one of the most common stressors, with ef-
fects that persist into adulthood. It disproportionately affects females.
Although deﬁnitions are still evolving, child sexual abuse is often de-
ﬁned as forcible touching of breasts or genitals or forcible intercourse
INCLUDING ANAL ORAL OR VAGINAL SEX BEFORE THE AGE OF OR %PIDE-
miology studies of adults in varying segments of the community have
FOUND THAT TO PERCENT OF FEMALES AND TO PERCENT OF MALES

20
Stressful Life Events

were sexually abused in childhood. A large epidemiological study of

ADULTS IN THE GENERAL COMMUNITY FOUND A LOWER PREVALENCE PER-
cent for females and 4.3 percent for males); however, the definition of
sexual abuse was more restricted than in past studies. Sexual abuse
IN CHILDHOOD HAS A MEAN AGE OF ONSET ESTIMATED AT TO YEARS OF AGE
In over 25 percent of cases of child sexual abuse, the offense was com-
mitted by a parent or parent substitute.
The long-term consequences of past childhood sexual abuse are pro-
found, yet vary in expression. They range from depression and anxiety
to problems with social functioning and adult interpersonal relation-
ships. Posttraumatic stress disorder is a common sequela, found in 33
to 86 percent of adult survivors of child sexual abuse. Sexual abuse
may be a specific risk factor for adult-onset depression and twice as
many women as men report a history of abuse. Other long-term effects
include self-destructive behavior, social isolation, poor sexual adjust-
ment, substance abuse, and increased risk of revictimization.
Very few treatments specifically for adult survivors of childhood abuse
have been studied in randomized controlled trials. Group therapy and
Interpersonal Transaction group therapy were found to be more effective
for female survivors than an experimental control condition that offered
a less appropriate intervention. In the practice setting, most psychosocial
and pharmacological treatments are tailored to the primary diagnosis,
which, as noted in the preceding text, varies widely and may not attend
to the special needs of those also reporting abuse history.

Domestic Violence
Domestic violence is a serious and startlingly common public health
problem with mental health consequences for victims, who are over-
whelmingly female, and for children who witness the violence. Domestic
violence (also known as intimate partner violence) features a pattern of
physical and sexual abuse, psychological abuse with verbal intimidation,
ANDOR SOCIAL ISOLATION OR DEPRIVATION %STIMATES ARE THAT TO PERCENT
of women are victimized annually in the United States. Pinpointing the
prevalence is hindered by variations in the way domestic violence is
deﬁned and by problems in detection and underreporting. Women are
often fearful that their reporting of domestic violence will precipitate
retaliation by the batterer, a fear that is not unwarranted.
Victims of domestic violence are at increased risk for mental health
problems and disorders as well as physical injury and death. Domes-
tic violence is considered one of the foremost causes of serious injury
TO WOMEN AGES TO ACCOUNTING FOR ABOUT PERCENT OF ALL ACUTE

Stress-Related Disorders Sourcebook, Third Edition

injuries to women seen in emergency departments. According to the

53 $EPARTMENT OF *USTICE FEMALES WERE VICTIMS IN ABOUT PERCENT
OF THE ALMOST HOMICIDES BETWEEN INTIMATES IN 4HE MENTAL
health consequences of domestic violence include depression, anxiety
disorders (e.g., posttraumatic stress disorder), suicide, eating disor-
ders, and substance abuse. Children who witness domestic violence
may suffer acute and long-term emotional disturbances, including
nightmares, depression, learning difﬁculties, and aggressive behavior.
Children also become at risk for subsequent use of violence against
their dating partners and wives.
Mental health interventions for victims, children, and batterers are
highly important. Individual counseling and peer support groups are
the interventions most frequently used by battered women. However,
there is a lack of carefully controlled, methodologically robust studies
of interventions and their outcomes. There is an urgent need for devel-
opment and rigorous evaluation of prevention programs to safeguard
against intimate partner violence and its impact on children.

Interventions for Stressful Life Events

Stressful life events, even for those at the peak of mental health,
erode quality of life and place people at risk for symptoms and signs of
mental disorders. There is an ever-expanding list of formal and infor-
mal interventions to aid individuals coping with adversity. Sources of
informal interventions include family and friends, education, commu-
nity services, self-help groups, social support networks, religious and
spiritual endeavors, complementary healers, and physical activities. As
valuable as these activities may be for promoting mental health, they
have received less research attention than have interventions for mental
disorders. Nevertheless, there are selected interventions to help people
cope with stressors, such as bereavement programs and programs for
caregivers as well as couples therapy and physical activity.
Couples therapy is the umbrella term applied to interventions that
aid couples in distress. The best studied interventions are behavioral
couples therapy, cognitive-behavioral couples therapy, and emotion-
focused couples therapy. A review article evaluated the body of evi-
dence on the effectiveness of couples therapy and programs to prevent
marital discord. The review found that about 65 percent of couples in
therapy did improve, whereas 35 percent of control couples also im-
proved. Couples therapy ameliorates relationship distress and appears
to alleviate depression. The gains from couples therapy generally last
through 6 months, but there are few long-term assessments. Similarly,

22
Stressful Life Events

interventions to prevent marital discord yield short-term improve-

ments in marital adjustment and stability, but there is insufficient
study of long-term outcomes.
Physical activities are a means to enhance somatic health as well
as to deal with stress. Aerobic physical activities, such as brisk walk-
ing and running, have been found to improve mental health for people
who report symptoms of anxiety and depression and for those who are
diagnosed with some forms of depression. The mental health benefits of
physical activity for individuals in relatively good physical and mental
health were not as evident, but the studies did not have sufficient rigor
from which to draw unequivocal conclusions.

23
Chapter 4

Factors That Inﬂuence

Response to Stress

Chapter Contents
3ECTION 0ERSONALITY AND 3TRESS ............................................ 26
Section 4.2—Men and Women Cope with
Stress Differently .................................................... 29
3ECTION 2ESISTANCE -ECHANISMS IN "RAIN
-AY 0REVENT 3TRESS 2ELATED )LLNESS .......................
Section 4.4—Chronic Stress and Loneliness
Affect Health ........................................................... 34
Section 4.5—Media Coverage Linked to Stress...........................

25
Stress-Related Disorders Sourcebook, Third Edition

Section 4.1

Personality and Stress

“Personality Traits Inﬂuence Ability To Withstand Stress,”
BY 2ICK .AUERT 0H$ ¥ 0SYCH #ENTRAL WWWPSYCHCENTRALCOM
!LL RIGHTS RESERVED 2EPRINTED WITH PERMISSION

Our ability to withstand stress-related, inﬂammatory diseases

may be associated, not just with our race and sex, but with our per-
sonality as well.
2ESEARCHERS DISCOVERED LOW LEVELS OF EXTROVERSION IN AGING WOMEN
may signal that blood levels of a key inflammatory molecule have
crossed over a threshold linked to a doubling of risk of death within
5 years.
An emerging area of medical science examines the mind-body con-
nection, and how personality and stress contribute to disease in the
aging body. Long-term exposure to hormones released by the brains of
people under stress, for instance, takes a toll on organs.
Like any injury, this brings a reaction from the body’s immune sys-
tem, including the release of immune chemicals that trigger inflamma-
tion in an attempt to begin the healing process. The same process goes
too far as part of diseases from rheumatoid arthritis to Alzheimer’s
disease to atherosclerosis, where inflammation contributes to clogged
arteries, heart attacks, and strokes.
The current study found that that extroverts, and in particular
those with high “dispositional activity” or engagement in life, have
dramatically lower levels of the inflammatory chemical interleukin
6 (IL-6).
Swiss psychiatrist Carl Jung defined extroverts as focused on the
world around them and most happy when active and surrounded by
people. Introverts looked inward and were shy.
The definitions of extroversion and other personality traits were
refined by American psychologist Gordon Allport beginning in the
S (E REVIEWED ALL ADJECTIVES IN THE DICTIONARY USED TO DESCRIBE
personality, and attempted to group them into clusters.
Over the next several decades, researchers statistically analyzed
these dictionary terms and discovered that they tended to cluster into

26
Factors That Inﬂuence Response to Stress

ﬁve general dimensions: extroversion vs. introversion, emotional stabil-

ity vs. neuroticism, open- vs. closed-minded, agreeable vs. hostile, and
conscientiousness vs. unreliability.
These dimensions, known as the “Five Factor Model” of personality,
served to organize hundreds of specific traits like “activity” for psy-
chologists, similar to the way the Periodic Table organizes elements
for physicists.
“Our study took the important first step of finding a strong asso-
ciation between one part of extroversion and a specific, stress-related,
inflammatory chemical,” said Benjamin Chapman, Ph.D., assistant pro-
FESSOR WITHIN THE 2OCHESTER #ENTER FOR -IND "ODY 2ESEARCH 2#-"2
PART OF THE $EPARTMENT OF 0SYCHIATRY AT THE 5NIVERSITY OF 2OCHESTER
Medical Center, and lead author of the study.
“The next step is to determine if one causes the other. If we knew the
direction and mechanism of causality, and it were low dispositional activ-
ity causing inflammation, we could design treatments to help high-risk
patients become more engaged in life as a defense against disease.”
Some past studies had contended, and the current analysis agreed,
that women and minorities have higher levels of IL-6 than white males
on average. Women may be more vulnerable to stress because of hor-
monal differences and minorities because of factors like perceived
racism, but those questions have yet to be fully answered.
While these trends exist, variations within these large groups are
so great that further risk markers are needed to better determine
any given patient’s actual risk. The current study looked at whether
particular personality traits, including low extroversion, were associ-
ATED WITH ), LEVELS IN A SAMPLE OF URBAN PRIMARY CARE PATIENTS
aged 40 and older.

You Must Have Been a Calm Baby

!CCORDING TO LANDMARK STUDIES IN THE EARLY S EXTROVERSION IS A
personality trait with three parts: A tendency toward happy thoughts, a
desire to be around others, and “dispositional energy,” a sense of innate
vigor or active engagement with life (“I’m bursting with energy; my life
is fast-paced”). Other dimensions of extroversion, such as sensation-
seeking, have also been proposed.
While the first two extrovert qualities were not found to track with
inflammation, the current study found increases in “dispositional ac-
TIVITYv CAME WITH STATISTICALLY SIGNIlCANT DECREASES IN ), P
P values measure the weight that should be attributed to a finding,
with values less than .05 usually deemed significant.

Stress-Related Disorders Sourcebook, Third Edition

In the current study, a patient’s degree of extroversion was deter-

mined by standard tests, including the NEO Five-Factor Inventory, an
instrument based on the Five Factor Model. The study found that the
difference between the 84th percentile of dispositional activity and
THE TH TRANSLATED ROUGHLY INTO A PICOGRAM PG INCREASE IN ),
per milliliter of blood.
Those findings took on meaning when comparisons revealed that,
for both white and minority women, the difference between high and
LOW DISPOSITIONAL ENERGY WAS ENOUGH TO SHIFT ), LEVELS ABOVE PG
ml, the threshold established by a large, epidemiological study (Harris
ET AL OVER WHICH lVE YEAR MORTALITY RISK WAS FOUND TO DOUBLE
“If this aspect of personality drives inflammation, dispositional
energy and engagement with life may confer a survival advantage,”
Chapman said. “But we don’t know if low dispositional activity is
causing inflammation, or inflammation is taking its toll on people by
reducing these personality tendencies, so we must be cautious in our
interpretation of this association.”
4HE lNDINGS RECALL AN IDEA DESCRIBED AS EARLY AS BY &RENCH
philosopher Henri Bergson that he called élan vitale or “life force,”
according to the authors. This aspect of adult personality may be
linked to childhood temperament as well. Some babies are very re-
laxed, others active. Activity level may reflect a fundamental, bio-
logically based energy reserve, although no one has explained the
biochemistry behind it.
The team gauged the magnitude of IL-6 associations for gender,
race/ethnicity, and personality by examining the degree to which each
factor was associated with differences between people in IL-6. Of the
differences in inflammation found in the patient sample in levels of
IL-6, about 9 percent of the difference was due to gender, 6 percent
was due to dispositional activity levels, and another 4 percent to race/
ethnicity. That a personality trait may contribute more to IL-6 levels
than race/ethnicity was “a great surprise.”
While it may be difficult for patients to change their nature, part of
the solution may be physical exercise as a therapy. The activity com-
ponent of extroversion has been linked with exercise by past studies,
as has daily physical activity with lower IL-6 levels in the aging. Still,
the team is not convinced that exercise represents the whole answer.
“Beyond physical activity, some people seem to have this innate
energy separate from exercise that makes them intrinsically involved
in life,” Chapman said.
“It will be fascinating to investigate how we can increase this dis-
position toward engagement. Potentially, you might apply techniques

28
Factors That Inﬂuence Response to Stress

developed to treat depression like ‘pleasurable event scheduling’ to pa-

tients with low dispositional energy, where you get people more involved
in life by ﬁlling their time with things they enjoy as a therapy.”
The study is published in the July issue of the journal Brain, Behav-
ior and Immunity 3OURCE 5NIVERSITY OF 2OCHESTER -EDICAL #ENTER

Section 4.2

Men and Women Cope

with Stress Differently
h0ENN 2ESEARCHERS 5SE "RAIN )MAGING TO $EMONSTRATE (OW -EN AND
Women Cope Differently Under Stress,” reprinted with permission from
HTTPWWWUPHSUPENNEDU ¥ 5NIVERSITY OF 0ENNSYLVANIA (EALTH
System.

!CCORDING TO A STUDY THAT APPEARED IN A ISSUE OF SCAN (Social

Cognitive and Affective Neuroscience), researchers at the University
of Pennsylvania School of Medicine discussed how men and women
differ in their neural responses to psychological stress.
“We found that different parts of the brain activate with different
spatial and temporal profiles for men and women when they are faced
with performance-related stress,” says J.J. Wang, PhD, Assistant Pro-
FESSOR OF 2ADIOLOGY AND .EUROLOGY AND LEAD AUTHOR OF THE STUDY
These findings suggest that stress responses may be fundamentally
different in each gender, sometimes characterized as “fight-or-flight”
in men and “tend-and-befriend” in women. Evolutionarily, males may
have had to confront a stressor either by overcoming or fleeing it,
while women may have instead responded by nurturing offspring and
affiliating with social groups that maximize the survival of the species
in times of adversity. The “fight-or-flight” response is associated with
the main stress hormone system that produces cortisol in the human
body—the hypothalamic-pituitary-adrenal (HPA) axis.
4HIRTY TWO HEALTHY SUBJECTS FEMALES AND MALESRECEIVED
F-2) FUNCTIONAL -AGNETIC 2ESONANCE )MAGING SCANS BEFORE DUR-
ing, and after they underwent a challenging arithmetic task (serial
SUBTRACTION OF FROM A DIGIT NUMBER UNDER PRESSURE 4O INCREASE

29
Stress-Related Disorders Sourcebook, Third Edition

the level of stress, the researchers frequently prompted participants

for a faster performance and asked them to restart the task if they
responded incorrectly. As a low stress control condition, participants
were asked to count backward without pressure.
The researchers measured heart rate, cortisol levels (a stress hor-
mone), subjects’ perceived stress levels throughout the experiments,
and regional cerebral blood ﬂow (CBF), which provides a marker of
regional brain function. In men, it was found that stress was associated
with increased CBF in the right prefrontal cortex and CBF reduction
in the left orbitofrontal cortex. In women, the limbic system—a part of
the brain primarily involved in emotion—was activated when they were
under stress. Both men and women’s brain activation lasted beyond the
stress task, but the lasting response in the female brain was stronger.
The neural response among the men was associated with higher levels
of cortisol, whereas women did not have as much association between
brain activation to stress and cortisol changes.
“Women have twice the rate of depression and anxiety disorders com-
pared to men,” notes Dr. Wang. “Knowing that women respond to stress
by increasing activity in brain regions involved with emotion, and that
these changes last longer than in men, may help us begin to explain the
gender differences in the incidence of mood disorders.”
Additional researchers involved with this study are Marc Korc-
ZYKOWSKI 0ENN (ENGYI 2AO 0ENN 9ONG &AN 0ENN *OHN 0LUTA 0ENN
2UBEN 'UR 0ENN "RUCE -C%WEN 4HE 2OCKEFELLER 5NIVERSITY AND *OHN
Detre, Penn. This study was conducted at the Center for Functional
Neuroimaging at the University of Pennsylvania.

30
Factors That Inﬂuence Response to Stress

Section 4.3

Resistance Mechanisms in
Brain May Prevent Stress-Related Illness
&ROM h3TRESS "RAIN 9IELDS #LUES !BOUT 7HY 3OME 3UCCUMB
While Others Prevail,” by the National Institutes of Health
.)( WWWNIHGOV /CTOBER

2ESULTS OF A STUDY MAY ONE DAY HELP SCIENTISTS LEARN HOW TO ENHANCE
a naturally occurring mechanism in the brain that promotes resilience
TO PSYCHOLOGICAL STRESS 2ESEARCHERS FUNDED BY THE .ATIONAL )NSTITUTES
of Health’s National Institute of Mental Health (NIMH) found that, in
a mouse model, the ability to adapt to stress is driven by a distinctly
different molecular mechanism than is the tendency to be overwhelmed
by stress. The researchers mapped out the mechanisms—components
of which also are present in the human brain—that govern both kinds
of responses.
In humans, stress can play a major role in the development of several
mental illnesses, including post-traumatic stress disorder and depres-
sion. A key question in mental health research is: Why are some people
resilient to stress, while others are not? This research indicates that
resistance is not simply a passive absence of vulnerability mechanisms,
as was previously thought; it is a biologically active process that results
in speciﬁc adaptations in the brain’s response to stress.
2ESULTS OF THE STUDY WERE PUBLISHED ONLINE IN Cell ON /CTOBER
;= BY 6AISHNAV +RISHNAN -ING (U (AN 0H$ %RIC * .ESTLER -$
PhD, and colleagues from the University of Texas Southwestern Medi-
cal Center, Harvard University, and Cornell University.
Vulnerability was measured through behaviors such as social with-
drawal after stress was induced in mice by putting them in cages
with bigger, more aggressive mice. Even a month after the encounter,
some mice were still avoiding social interactions with other mice—an
indication that stress had overwhelmed them—but most adapted and
continued to interact, giving researchers the opportunity to examine
the biological underpinnings of the protective adaptations.
“We now know that the mammalian brain can launch molecular ma-
chinery that promotes resilience to stress, and we know what several

Stress-Related Disorders Sourcebook, Third Edition

major components are. This is an excellent indicator that there are

similar mechanisms in the human brain,” said NIMH Director Thomas
2 )NSEL -$
Looking at a specific part of the brain, the researchers found differ-
ences in the rate of impulse-firing by cells that make the chemical mes-
senger dopamine. Vulnerable mice had excessive rates of impulse-firing
during stressful situations. But adaptive mice maintained normal
rates of firing because of a protective mechanism—a boost in activity
of channels that allow the mineral potassium to flow into the cells,
dampening their firing rates.
Higher rates of impulse-firing in the vulnerable mice led to more
activity of a protein called BDNF [brain-derived neurotrophic factor],
which had been linked to vulnerability in previous studies by the same
researchers. With their comparatively lower rates of impulse-firing, the
resistant mice did not have this increase in BDNF activity, another
factor that contributed to resistance.
The scientists found that these mechanisms occurred in the reward
area of the brain, which promotes repetition of acts that ensure sur-
vival. The areas involved were the VTA (ventral tegmental area) and
the NAc (nucleus accumbens).
In a series of experiments, the scientists extended their findings
to provide a progressively larger picture of the vulnerability and re-
sistance mechanisms. They used a variety of approaches to test the
findings, strengthening their validity.
“The extensiveness and thoroughness of their research enabled
these investigators to make a very strong case for their hypothesis,”
Insel said.
For example, the researchers showed that the excess BDNF protein
in vulnerable mice originated in the VTA, rather than in the NAc.
Chemical signals the protein sent from the VTA to the NAc played an
essential role in making the mice vulnerable. Blocking the signals with
experimental compounds turned vulnerable mice into resistant mice.
The scientists also conducted a genetic experiment which showed
that, in resistant mice, many more genes in the VTA than in the NAc
went into action in stressful situations, compared with vulnerable
mice. Gene activity governs a host of biochemical events in the brain,
and the results of this experiment suggest that genes in the VTA of
resilient mice are working hard to offset mechanisms that promote
vulnerability.
Another component of the study revealed that mice with a nat-
urally occurring variation in part of the gene that produces the
BDNF protein are resistant to stress. The variation results in lower

32
Discovering Diverse Content Through
Random Scribd Documents
CHAPTER VIII
A RUNAWAY TREE

Snythergen gave a sigh of relief when the bear went away and
was just about to step out and un-bark, when he heard voices.
“This is the tree we are to chop down!” Snythergen heard one of
them say, and already the woodchopper was swinging his axe.
Snythergen did not wait for the blow to land, but leaped into the air
and was off as fast as his roots would carry him. To be sure, he was
hampered by his leaves and his branches and his sheath bark skirt.
Brushing none too gently against bushes and trees he trod on the
toes of innumerable growing things. Apologizing with his bows to
right and left, he did not pause even to see what damage he had
done, nor did he know he had stepped heavily on the roots of an
oak, or rubbed the shins of a birch. He knew only that two
woodsmen were after him, threatening to chop him into kindling
wood.
“Did you ever see such a rude tree?” cried a graceful elm suffering
from a broken limb. “And it’s so untreelike to run away like that!
Suppose the rest of us did likewise—what would become of the
forest!”
“If he is restless, I don’t object to his walking about in a
gentlemanly manner,” said the birch whose shins had been rubbed,
“as long as he picks his steps carefully; but to go slamming through
regardless of the rest of us is most inconsiderate!”
There was much bobbing of tree-tops and angry shaking of limbs
in the direction the runaway tree had taken. But Snythergen might
have saved himself running so far and so fast, had he taken the
trouble to look around. For the hunters were not following but
standing still, astonished at the spectacle of a tree racing through
the forest at break-limb speed. In all the years they had lived in the
woods never had they seen a runaway tree before.
“Is the forest going crazy?” cried one. “What if all the trees were
to run after us like a herd of buffalo! What chance would we have of
escape?”
The mere thought of it was so terrifying they turned and ran,
leaving coats, rifle, and axes where they lay, and they did not stop
until they were well out of the woods and safe in their own home,
behind locked doors and windows. And they did not stir abroad for
two days.
When Sancho Wing saw the hunters and Snythergen running
away from each other in opposite directions, it was too much for
him. He laughed and laughed, and shook so that he fell from the
limb he was perched on, and only saved himself from a bad fall by
using his wings.
“Surely I have paid Snythergen now for all of his tricks,” he cried
merrily.
During all this time Squeaky actually had remained asleep in
Snythergen’s top branches, though his rest had been somewhat
uneven.
“Where am I?” he cried, rubbing his eyes and waking up to find
himself violently tossed about, and bumped against the branches of
trees as Snythergen crashed through the forest.
With a breathless word here and there as he ran, Snythergen gave
the pig an idea of what had happened, and when Squeaky realized
all the dangers he had slept through, he lost his grip and would have
fallen had Snythergen not tightened his hold. On and on ran the
tree, stumbling and reeling, and with every lurch Squeaky’s little
heart quivered; for tree-riding was as terrifying as hanging to the
top of a mast in a storm at sea. What a relief when Snythergen
slowed up and stopped at the shore of a lake, panting like a
porpoise!
“I think you had better get down now,” said Snythergen, “for I am
going to wade across that lake and plant myself in the farmer’s yard
on the other side. I shall remain there until the woodchoppers get
tired of looking for me. I believe my leg is cut. Will you look on the
ground and see if I am bleeding?”
“I guess your leg isn’t bleeding,” said Squeaky after looking
around, “for I don’t see any sawdust.”
“Would you mind running home now, Squeaky, just to see that
Sancho Wing is all right? I am a little worried about him. But if you
will come back to this spot twice a day I will signal across the lake to
let you know how I am getting on.”
Very much shaken Squeaky limped home following the broad trail
Snythergen had made through the woods, and found Sancho Wing
still chuckling. After talking over their adventure for a little while
they settled themselves for a nap.
As soon as Squeaky left him, Snythergen waded into the lake. He
found the cool water refreshing to his overheated roots and tattered
branches, but when he bent over to drink he came near losing his
balance and floating away.
Only while he stood erect and kept in shallow water did his roots
find a firm footing on the bottom of the lake. With much splashing of
water and stirring of mud, and by wading around the deep places he
managed to cross. When no one was looking, he crept into the
farmer’s yard, where he hoped to find an end to his troubles. After
looking the place over, he decided to plant himself where he would
shade the dining-room window and could see what the family had
for dinner. It occurred to him that if he became very hungry, he
might reach through the window and help himself to a morsel of
food. “Turn about is fair play,” he reasoned. “If I provide shade for
them, they should not begrudge me a bite to eat now and then!”
Luckily the farmer and his wife were away at camp meeting when
Snythergen arrived, and when they returned, it was dark. A crescent
moon and the stars revealed but a dusky outline of the place.
“Somehow things don’t look natural around here,” said the farmer
when he reached home. “The place seems changed, swelled out!
Why, I believe the house has got the mumps!”
“Silas, you don’t think baby has the mumps, do you?” cried his
wife, thinking he must be referring to their child.
“No, no, it’s the house that’s got the mumps,” said the farmer.
“Nonsense, Silas, you must be out of your mind!” she said. She
saw nothing out of the way, for her eyes sought only the windows of
a room on the other side of the house where her small son had been
left, and nothing more was said about the matter that night.
CHAPTER IX
THE DOCTOR DISCOVERS A TREE WITH ST.
VITUS’ DANCE

The next morning the discovery of a new tree in the farmer’s yard
caused great surprise. At first the people were awed and afraid, and
some were a little suspicious. Indeed, Snythergen had to stand very
stiff and still and put on his very best tree manners to make them
believe he was a real tree. He was watched so closely that he
scarcely dared to breathe, and he feared the cool breeze from the
lake might make him cough, for already he had a slight cold from
wading in the chilly water the day before. Once or twice he nearly
exploded trying to hold in a sneeze. But the people on the ground
saw only his top branches tossing and thought it due to an upper
current of air.
Then an adventurous boy began climbing his trunk, and
Snythergen thought surely the little fellow would feel his heart beat.
But the child only climbed higher and higher, venturing out on a high
limb which Snythergen held insecurely with the thumb and forefinger
of his left hand. It had been difficult to support the branch alone and
keep it from swaying, but with the heavy boy on it Snythergen found
it almost impossible. The perspiration stood out on every bough. His
left arm became so tired it pained him dreadfully, and it took all his
strength to keep from dropping it to his side. He knew that he could
not hold it out much longer, and yet if he let the branch drop the boy
would be dashed to the ground and perhaps cruelly hurt. In spite of
all he could do he was horrified to see the limb settling slowly
downward and he closed his eyes to shut out the catastrophe that
seemed sure to follow. Suddenly there was a cry from below.
“Get right down out of that tree,” called the mother of the boy.
Snythergen braced himself to hold on a moment longer, and just as
the boy reached his trunk, the branch fell to his side. Snythergen
breathed a prayer of thanksgiving. The child soon was safe on the
ground.
Snythergen thought the people in the farmer’s yard curious and
watchful, but he was mistaken. He was soon to learn what real
curiosity and watchfulness are like. Some one had sent for a famous
tree doctor, and he came promptly to look Snythergen over. When he
appeared Snythergen put on his most correct forest behavior and
really was a model tree, for the doctor’s benefit.
“I can’t see anything unusual about that tree,” said the physician,
unpacking his instrument case. Snythergen was holding out his
branches gracefully and letting his leaves flutter naturally in the
breeze. The doctor spread his shining wood-carving tools out on a
cloth on the ground. Much as the little man knew about trees, he
had never learned to climb one, and the farmer had to fetch him a
long ladder before he could make his examination.
When the little man had mounted well up toward the top of
Snythergen he placed a fever thermometer in a knothole, which
happened to lead into Snythergen’s mouth. Leaving it there he
descended to the ground, and wrapped a rubber bandage about his
trunk, winding it so tightly that Snythergen barely avoided a cry of
pain. One look at the indicator gave the tree doctor a shock.
“Sap pressure 110!” he cried. “There must be some mistake!”
Again and again he tried it and each time it registered 110.
“Surely there is something very strange here!” said the doctor.
“Never have I heard of a tree with a sap pressure over 30. Why, it’s
as high as the blood pressure of a boy!”
But the tree doctor was to receive another shock when he tapped
Snythergen’s bark and listened with a tree stethoscope.
“Why, I didn’t think there was a tree in the world with such a
violent throb. It’s as fast and strong as the heart beat of a child!”
But the greatest shock of all was to come when he climbed up to
read the fever thermometer. He could hardly believe his own eyes
when he saw what it registered.
“I never heard of a tree having such a temperature!” he cried. “It
is as high as a boy’s.” Indeed the temperature was so much like a
boy’s, the little doctor so far forgot himself as to shout:
“Stick out your tongue!”
“Stick out your tongue!”
This command took Snythergen by surprise, and without thinking,
he stuck his tongue out through the knothole, and when the little
man saw it, he was so frightened he nearly fell from the ladder.
Snythergen drew back his tongue in a hurry. The doctor puzzled and
puzzled over the matter. Finally he concluded that he must have
seen a squirrel’s red head.
There were so many strange things about the tree that the
physician made up his mind in the interest of science to watch it day
and night. He camped in a tent beside Snythergen, and only when
he retired for a cat nap did he take his owl-like eyes from the tree.
Even then Snythergen could not attempt to escape, or even stretch
his limbs and relax, for the little man was a light sleeper and would
rush out at the faintest unusual rustle of a twig.
Snythergen realized more than ever that the life of a tree is not all
joy. His roots were sore and calloused from standing in one position.
A leg or an arm would go to sleep because he dared not move it. He
was numb all over, besides being cold, tired and hungry. He gazed
longingly into the dining room. His mouth watered and he swallowed
hard at the sight of the rich home cooking. How eagerly would he
have eaten the crusts the farmer’s little boy tried to hide under the
edge of his plate! How he would have enjoyed taking the heaping
plate of his tormentor, the little doctor, when the latter’s back was
turned! But usually the window was closed, or some one was
looking.
All the next morning Snythergen watched impatiently for Squeaky
to appear on the opposite shore of the lake. He wondered why
Sancho Wing did not come, but he could not know that Sancho was
spending all of his time keeping track of the bear, who was in a
revengeful mood and very restless. The ice had given him mental
chilblains and the pain served as a reminder, making him more
determined than ever to find and punish his persecutors.
About eleven o’clock Snythergen thought he saw a little movement
in the bushes along the opposite shore of the lake. Then he
recognized Squeaky’s peculiar wobbling walk. So delighted was he
that he forgot the little doctor, and waved his branches excitedly.
Squeaky answered. Snythergen signaled back that he was hungry
and wanted some bread and butter with sugar on it—not an easy
message for a tree to wave to a pig all the way across a lake. It took
ingenuity to figure it out, and this is how he did it.
First Snythergen held out two limbs and pretended he was
carrying a slice of bread in each hand. Next he rubbed an upper
branch over these in such a way that Squeaky would know he
wanted them spread with butter—and not to save on the butter.
Then he bent his top boughs down, shaking them vigorously to
make the pig understand that he wanted all the powdered sugar the
bread would hold.
The little tree doctor was watching this performance with the
utmost amazement.
“Why, I believe that tree has the St. Vitus’ Dance!” said the
physician. “I never heard of a tree having it before. The discovery
will make me famous. But I must prove it beyond a doubt or the
scientists will never give me credit for it. In order to be sure I must
give it the brass band test for that is the only reliable one. If our
leafy friend here dances when the band plays I will know then that
he has the St. Vitus’ Dance. If he does not, I may have to ‘tree-pan’
him to find out.”
Snythergen shuddered at the horrible thought of being trepanned
—or in other words of having his skull operated on so his brain could
be examined. As he talked to himself the little man danced excitedly
about.
“The fit seems to be over,” he said breathlessly, when Snythergen
had waved his last signal to Squeaky.
“Dinner is ready,” called the farmer’s wife from the house.
“I will be right in,” answered the doctor, for he had decided to wait
until he had eaten before going for the musicians.
The chance of running away to meet Squeaky and bread and
butter had become more and more doubtful now the little doctor
had seen him waving, and Snythergen was so hungry! He looked in
through the dining-room window to see what the family was having
to eat. It was a very hot day and the window was wide open. The
farmer was placing a steaming plate of meat and potatoes before
the doctor, who sat facing the window where he could watch the
tree while he ate. The rich odor of food arose to Snythergen’s
nostrils and it was more than he could resist.
“I must have something soon, or I’ll fall over,” he said to himself.
“I wonder how I can manage it?” For a moment he thought, then an
idea came to him. Leaning over, with his top branches he beat
violently upon the roof of the house.
“What’s happening upstairs!” cried the farmer’s wife in alarm.
“It sounds as if the roof was falling in!” said the farmer leaping
from his chair, and they rushed out of the room. In his excitement
the doctor followed part way upstairs. The instant he was gone
Snythergen reached a forked limb into the dining room and helped
himself to the doctor’s dinner.
“He will never miss it,” he thought. “He’s too excited to eat,
anyway.”
When the physician returned and found his dinner had
disappeared, he was dumbfounded.
“What has become of it?” he cried, jumping up and looking under
the table. He searched behind the chairs, in the closets, and even in
the hall. In each new place he cried out over and over again, “Who
took my dinner? Who took my dinner?”
While he was thus occupied Snythergen had an opportunity to eat,
but he was in such haste to be done before his tormentor looked out
of the window again, that he entirely forgot his table manners and
crammed and stuffed his mouth with his twigs. The farmer and his
wife had found nothing out of the way upstairs to explain the noise
on the roof, and when they returned the little man was still fussing
about, looking in the china closet, the napkin and silver drawers, and
other absurd places.
“What’s up now?” demanded the farmer, who was getting a bit
tired of the tree doctor’s queer ways. The farmer’s wife too was
looking on suspiciously. She did not fancy having a stranger poking
into her drawers and closets.
The physician tried to explain but they only laughed at him.
“The very idea!” cried the farmer’s wife. “Nobody could come into
the room and take your dinner away without your knowing it!”
“Besides, who would want something to eat that bad around
here,” said the farmer. “Everybody knows we feed every tramp that
comes along!”
The little doctor felt uncomfortable and embarrassed because they
laughed at him, and he barely touched the second plate of food the
farmer served him. Snythergen was right, he was too excited to eat.
Scarcely could he wait until the dinner was over for the farmer to
drive him to town to get the band.
Thereafter he would strike a tree-like pose not so difficult
to hold

The doctor’s departure was Snythergen’s cue to escape. Cautiously

he stole away from the house and waited for an opportunity to cross
the lake. The man next door was plowing, and Snythergen had to be
very careful. While the man’s back was turned he ran as fast as
possible, but when he plowed toward him, Snythergen had to stand
motionless and trust that his altered position would not be seen; and
whatever position Snythergen’s limbs were in when the farmer
turned toward him, had to be held while the plow traveled the whole
length of the field. Once when the man approached, Snythergen was
in the lake with one root raised ready to step, and he dared not
lower his root or make any other movement until the farmer had
walked the whole distance and had turned his back again. Thus he
stood balancing himself for fifteen minutes, and to make matters
worse he had been caught with his branches pointing to the sky. The
painful experience of holding this position taught him a lesson, and
thereafter when the plow neared the end of the row, he would strike
a tree-like pose not so difficult to hold. Luckily the farmer was near-
sighted, and failed to remark the strange apparition of a tree wading
across the lake up to its branch pits in water.
In spite of various discomforts Snythergen made the crossing
successfully and had no difficulty in following the trail home. On
reaching the house he found Sancho Wing and Squeaky feverishly
preparing the bread and butter and sugar to take to him. They were
overjoyed to see him, but Snythergen was too tired to sit up and
visit. He had been standing on his roots so long he was only too glad
to lie down and sleep. But before he would close his eyes, they had
to assure him that the woodchoppers had left the forest.
CHAPTER X
THE BEAR SEES THE “GRASSHOPPER PIG,”
HEARS THE “HUNTSMEN” AND IS PRESENT AT
THE “ESCAPE”

When Snythergen woke up, Sancho Wing was sorry to have to tell
him that the bear had resumed his midnight prowlings and might call
upon them at any time.
“We must prepare to defend ourselves,” said Sancho wisely, as he
perched on Snythergen’s ear.
“How can a pig defend himself from a bear?” asked Squeaky,
absent-mindedly biting one of Snythergen’s toes.
“Simple,” said Sancho. “Give him what he wants. You flatter
yourself if you think he wants you. He is after food, that is all.”
“Well, let us give it to him,” said Snythergen, “as long as he
doesn’t share Squeaky’s weakness for toes.”
“Just what I was thinking,” said Sancho. “Let us set a bear lunch
every night, and to make sure he will find it we must spread it in a
circle around the house. Then, no matter from what direction the
bear approaches, he will find something to eat across his path.”
“I’ve heard that round foods make people fat,” said Snythergen.
“Maybe food served on a round table will make the bear fat.”
“That wouldn’t help us any,” said Sancho Wing, “for fat bears are
as dangerous as lean ones.”
“Won’t it be pretty expensive boarding a bear?” asked Squeaky.
“Of course,” said Sancho Wing, “but if we find we can’t afford to
feed him we can build an airplane and journey to a land where there
are no bears. We may have to travel to the end of the sky to find
such a place, but who cares?”
At Sancho Wing’s suggestion Snythergen set to work at once to
build a supper table. When completed it encircled the house and
resembled a well planed sidewalk. That night Squeaky set the table,
being careful to spread the food so thin that it went all the way
around.
There were so many hungry beings in the forest besides the bear
that Sancho Wing had to keep a keen look-out for thieves, and his
duties kept him very busy. One minute he would be scanning the
woods from the top of his tower, the next he would dive down to the
round table to scream at the small animals that were forever
nibbling. Often he was obliged to call Squeaky and even Snythergen,
to chase away the larger birds, the rabbits, and the squirrels. Each
night they set the table as late as they dared to prevent so much of
the food being stolen.
On the evening of the fourth day the bear paid them a call, but he
did not attempt to enter the house. The lunch on the round table
stopped him. Walking all the way around he ate everything, then
went around again to see if he had overlooked any crumbs. Squeaky
happened to be very fussy about table manners, and he had
scattered salad forks, finger bowls and napkins here and there
hoping the bear would take the hint; but the big beast paid no
attention to them, and ate only with his knife and his paws in the
most vulgar manner.
The bear was a hearty eater and what made matters even more
serious, his appetite was growing. Soon it was evident that the food
supply would not last much longer. The three friends realized that
the “outer works” as they called the lunch table, was all that stood
between them and disaster. And now in spite of their efforts they
were unable to keep abreast of the beast’s increasing desire for
food. There was nothing to do but to adopt Snythergen’s plan of
building an airplane and fleeing to a land where there were no
bears. They began work immediately and hurried all they could, but
even so they ran out of food when there was still another day’s work
to be done on the plane.
“If we can only keep him away to-night we are saved,” said
Squeaky.

Then went around again to see if he had overlooked any

crumbs
Snythergen dressed in his tree suit to be ready in case of trouble.
Carefully Squeaky set the round table with what few morsels he
could scrape up, arranging them to appear like a bountiful meal. The
bear came a little earlier than usual that night, and made short work
of the slim repast. Indeed Snythergen had just time to tiptoe out
and take his place as a tree when the beast devoured the last bite of
food and looked hungrily about for more. In a stage whisper
Snythergen called to Squeaky who was still in the house, to warn
him of his danger. Fortunately the pig was awake and whispered
back that he was coming. A moment later Snythergen heard the
most awful squealing and Squeaky came running out, the bear after
him. Sancho Wing was flying above the pig to encourage him.
“Don’t squeal so! Save your breath for running!” he cried. The
bear was gaining. Bending over Snythergen touched his roots with
his top limbs, to be ready. But Squeaky was slow on his feet, even
when running for his life, and already the bear was upon him. Sure
of his prey the great beast slowed up to brace himself for a lunge.
Quick as lightning Snythergen shot out his branches and grabbed
the pig, lifting him to safety.
The bear did not suspect that a tree could come to the rescue of a
pig, and so sure was he that his victim could not escape, he closed
his eyes as he struck at him. But he opened them quickly enough
when his paw struck nothing solider than air. The pig had vanished!
But where, and how? His disappearance had been as sudden as it
was complete, and the bear had not an idea where to look for him.
Too surprised for growls, the big brute rushed distractedly about
looking here and there. Naturally it did not occur to him to look up
into the tree tops, for whoever heard of a pig climbing a tree!
“Did I really see a pig at all?” thought the bear, “or am I losing my
mind! It wouldn’t be surprising with that neuralgia from the ice!”
He paused as the thought struck him: “I wonder if by any
possibility it could have been the Grasshopper Pig?”
The day before the bear had been reading the story of the
Grasshopper Pig to a neighbor’s cubs out of a book of nursery
rhymes called “Mother Moose.” This pig seemed to disappear in
much the same way as the one in the story. For the Grasshopper Pig
is said to make long leaps so suddenly that he cannot be seen
making them. One moment he is standing beside you and the next,
bingo! he is a hundred feet away!
“Well, if it’s the Grasshopper Pig, I might as well save myself the
bother of looking,” thought the bear; “no one has ever been able to
catch him!”
As he came to the place where Snythergen was standing he
sniffed curiously, and although Snythergen did his best to stand still,
it is not surprising that he failed. For it takes something stronger
than flesh and blood to stand still while a bear walks around you and
stops to paw your bark, to rub his hungry head against your trunk,
or to try his vicious teeth on your roots.
No wonder the trunk of the tree trembled and its branches
twitched nervously. The big animal was puzzled by the shaking as he
nosed about Snythergen’s extremities and clawed at them. It was
more than wood and sap could stand and the badly frightened boy
was weakening rapidly. Again Snythergen felt the sinking feeling that
had come over him the day the small boy had crawled out on an
upper branch. Tottering from side to side, he caught himself with an
effort.
For a while Squeaky managed somehow to hold on with his teeth
and legs, but his teeth were chattering and he was shivering all over
with terror. And a sudden twist of the tree shook him so violently
that he lost his footing. Desperately he reached for a limb. He
missed it, and fell crashing through the branches!
With remarkable quickness of thought Snythergen brought his
lower limbs together to form a basket in which to catch the falling
pig. Plunging through the branches Squeaky landed upon
Snythergen’s leafy chest, safe for the time being, but stunned and
out of breath.
“It is the Grasshopper Pig,” cried the bear, seeing him, “and I’ve
got him up a tree!”
Eager to get at Squeaky, he pawed Snythergen’s tender bark and
pushed against him roughly.
All this time Sancho Wing’s little brain had been puzzling to find
some way to save his pals. Flying a little distance and hiding among
the leaves he hallooed at the top of his piping voice, hoping the
woodchoppers might be in the forest, and hear him. Anxiously the
bear glanced around. The hallooing reminded him of the sound the
hunters made, and thinking best not to take any chances he strolled
away cautiously.
The three friends breathed a sigh of relief and Squeaky began to
dance for joy.
“We haven’t escaped yet,” Sancho Wing reminded him. “The bear
will return when he discovers the hunters are not after him. We
must finish the airplane immediately.”
At once they resumed work and kept at it until the plane was
completed. And now it needed only to be tested. It was new and
stiff and repeatedly the engine refused to start, though Snythergen
cranked it again and again. It was nearing the bear’s lunch time and
Sancho Wing flew away to the cave to see what the big brute was
up to. Soon he came back out of breath, panting so hard he could
scarcely speak, for he had raced all the way.
“Quick, quick!” he gasped.
Snythergen and Squeaky understood and Snythergen cranked so
furiously he was wet through with perspiration.
“Let me try it,” urged Squeaky impatiently when Snythergen had
to rest a moment to get breath, and the pig grasped the crank and
pulled with all his strength. But he had turned it only half way round
when it flew back, and sent him sprawling. Sancho, who had flown
back to keep track of the bear, now darted up to report him only a
few hundred yards away.
“Crank as if your life depended on it!” he cried.
Frantically the little bird flew back and forth to tell them each time
how much nearer the bear had come. Snythergen was cranking
mightily while Squeaky piled in what scanty luggage could be
collected in a jiffy.
“He’s almost here!” groaned Sancho Wing.
Snythergen heard the crackling of sticks under the brute’s feet.
“It’s now or never,” thought he, putting all his strength into one last
pull. The engine gave a sickly “pop.” Snythergen’s heart sank. But
there was another little “pop.” Others followed slowly, then more
rapidly. Now the explosions were in quick succession. The engine
was running! The three scrambled aboard. The airplane coasted
down hill and rose gently from the ground. They were saved.
CHAPTER XI
THE JOURNEY TO THE WREATH—A SPIN IN A
HUMMING-TOP—AN UNKNOWN FRIEND

The plane had to be an exceedingly large one to accommodate

Snythergen’s great length. With much squirming he managed to get
out of his tree suit, and now he lay face down, his feet hanging out
over the tail. In this position his hands came just right for the
controls. Sancho Wing’s compartment was next to Snythergen’s ear
and Squeaky occupied a basket on the opposite side. Sancho would
have liked going back a little way for a last look at the bear, just to
make sure they had left him on the ground but the wind created by
their great speed was too strong for a finch to fly in, and the little
bird would have been blown away had he ventured out. For some
strange reason the nose of the plane kept pointing up in spite of
Snythergen’s efforts to keep the machine horizontal.
“Either there is something wrong with the steering gear,” said
Snythergen, “or there is some unusual weight behind that keeps
heading the bow up by pulling the tail down. I can’t point her below
that big star—the one that looks like a flaming doughnut.”
“You will have to keep her on the star then,” said Sancho, “for if
anything is riding under the tail it isn’t safe for any of us to go back
to see what it is.”
All night long Snythergen steered toward the blazing doughnut,
which grew bigger and bigger, they were approaching it so rapidly.
“It must be some new planet floating very near the earth. Maybe
we can land on it to-morrow,” said Snythergen to Squeaky, but the
pig did not answer, nor even look up. He was rolled up in a tight ball,
his head under his body, fast asleep.
“Some unusual weight behind that keeps heading the
bow up by pulling the tail down”

By daylight the star seemed very near, but it no longer sparkled.

Now it resembled a huge Christmas wreath, tied with a gorgeous
bow of red silk ribbon which hung down in vast folds. Snythergen
steered for the center of the hole, then turning and mounting to the
top he made a landing along the shady side of a grove of pines. The
jolt when they struck the ground wakened Squeaky, and glancing
around he thought he saw a prowling shadow alight from the rear of
the plane and disappear into the woods. The others looked but saw
nothing.
“It looked like a bear,” said Squeaky with a shudder.
“Nonsense, you’ve got bear on the brain,” said Snythergen.
Near where they had landed an enormous boy was playing
marbles with bowling balls. He was nearly as tall as Snythergen and
heavier.
“Hooray! There’s some one I can talk to without bending down to
the ground,” cried Snythergen joyfully. “I can play with him without
being afraid of stepping on him.” And he strolled up to watch him
play marbles while Sancho Wing and Squeaky remained at a safe
distance, a little awed by the bigness of two such giant boys.
“Want to play?” asked the boy, whose name was Blasterjinx.
“Yes,” said Snythergen, and the two shot the big ten pin balls
about as if they were peas.
“Let’s spin tops,” said Blasterjinx after Snythergen had won most
of his marbles and paid back what he had borrowed.
“This is a hummer,” said the boy, taking a colored top from under
his blouse and winding it with a string as thick as a clothes-line. He
hurled it through the air and it landed upright on its point, spinning
so rapidly it seemed standing still, and as it spun it sang.
Interested in the big top, Sancho Wing and Squeaky edged closer
and closer.
“Why, it sounds like canary birds!” cried Snythergen delighted.
“It ought to!” said Blasterjinx.
“Why?”
Taking the top in his hand Blasterjinx unscrewed the upper part.
“See,” said he. Snythergen looked inside, and beheld a flock of
canaries singing and flying about.
“This is the only kind of humming-top to have”

“This is the only kind of a humming-top to have,” said Blasterjinx.

“For you can change the music any time you want to. I’ve tried
violinists, pianists, story-tellers, singers, harpists—almost everything
you can think of, but I like canaries best. Wouldn’t your friends here
like to take a spin?” he asked, pointing to Squeaky and Sancho
Wing.
It happened to be just what they wanted most, so Blasterjinx
opened a trap door in the floor of the room inside the top, and
shooed the canaries downstairs into the top basement, telling them
to remain silent. Then Squeaky and Sancho Wing descended a silver
ladder into the huge top, and the cover was screwed on. They found
themselves in a pleasant circular room, dimly lighted by stained
glass windows and ventilated by air holes. The objects in the room,
piano, chairs, pictures, all were fastened securely to hold their
positions when the top wobbled or fell to its side. A brass railing
attached to the wall ran all the way around, to give the passengers
something to hold to.
“Hold on tight now,” said Blasterjinx, and winding the top carefully
he hurled it through the air. It lighted on its point, spinning at terrific
speed. Through one of the ventilating holes Squeaky watched the
topsy turvey landscape dance giddily about, until it made him dizzy
and soon he became ill from it. Sancho Wing was too busy keeping
his balance and holding on, to pay any attention to how Squeaky
was getting along.
“Stop the top, stop the top!” bellowed Squeaky.
“What’s the matter?” cried Snythergen.
“He’ll be all right in a minute,” said Blasterjinx, taking the top in
his hand and winding the string the other way around. When he
threw it again it spun in the opposite direction, unwinding Squeaky
and as Blasterjinx had said, he was all right in a minute. But he was
glad when the top stopped and he could get out.
Snythergen was having such a good time that he forgot why they
had come until Sancho Wing flew up to his ear and whispered: “Ask
him if there are any bears on the Wreath.”
“I never heard of any,” said Blasterjinx, when the question had
been repeated to him. “I am sure you will like the Wreath,” he went
on, “for a good friend of yours lives not far from here.”
“How can you know he is a friend of ours?” asked Sancho Wing in
surprise. “You do not know who our friends are!”
“I know this man is your friend just the same, but I am not going
to tell you who he is because I want it to be a surprise.”
“Have I ever seen him?” said Squeaky.
“I don’t think so,” said Blasterjinx, “but I am sure he has been in
Snythergen’s house.”
“Where does he live?” asked Snythergen.

“Stop the top, stop the top!” bellowed Squeaky

“In a very big house about a mile from here. You can visit him
later on, but first I want you to spend a week with me and see some
of the sights on the Wreath. Your friend overworked himself last
Christmas and needs another week of rest.”
It made Snythergen homesick to go to Blasterjinx’ house and meet
his parents, for they were small like his own father and mother and
their house was not very large either, except Blasterjinx’ room which
was a separate building covering most of the yard. Blasterjinx’
mother was a kind soul and made her visitors feel very much at
home with the aid of doughnuts, cookies and pies. Somehow this
made Snythergen feel better, although his mother and father were
always in his thoughts.
The three friends told Blasterjinx about their adventures, and he
became so interested he wanted to play tree at once. He tried on
Snythergen’s suit of green but it was not big enough in the waist for
him, and when he squeezed into it the bark began to rip.
“You will tear it,” cried Blasterjinx’ mother, “and then Snythergen
won’t be able to wear it—for I am sure I don’t know how to mend
torn bark. I might sew it with a pine needle, but I wouldn’t know
what to use for thread.”
“Let’s make Blasterjinx a suit for himself,” cried Sancho Wing; and
delighted with the idea they set to work. Blasterjinx was just the
right build for a sturdy oak, and they fastened acorns all over his
suit, and made his bark gnarly and his branches twisty. They tried to
teach him the habits of an oak, but he did not learn readily. For
being a tree did not come natural to him as it did to Snythergen. He
was too restless to stand still very long.
“He’ll never make the birds think he is real,” whispered Sancho
Wing to Squeaky.
“Perhaps it is just as well,” replied Squeaky, looking at Sancho
Wing out of the corners of his little eyes, “for then he won’t be
bothered with any goldfinch nests tickling his branches!”
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Alzheimer Disease Sourcebook 5th Edition Amy L. Sutton

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Disabilities Sourcebook 2nd Edition Amy Sutton

Eating disorders in women and children prevention stress

Multiple Myeloma and Related Disorders 1st Edition Gösta

Molecular Neurobiology of Alzheimer Disease and Related

Animal Models of Schizophrenia and Related Disorders 1st

Fatty liver disease NASH and related disorders First

Library of Congress Cataloging-in-Publication Data

Electronic or mechanical reproduction, including photography, recording, or any other infor-

Printed in the United States

Part I: Introduction to Stress and Stress-Related

Chapter 3—Stressful Life Events ................................................ 19

Part II: How Stress Affects the Body

Chapter 9—Asthma .................................................................... 77

Chapter 10—Cancer and Stress ................................................... 85

Chapter 14—Headache and Its Link to Stress.......................... 121

Chapter 16—Infertility and Stress ............................................ 145

Chapter 20—Pregnancy and Stress ........................................... 185

Chapter 22—Sleep ...................................................................... 205

Chapter 23—Teeth Grinding (Bruxism) .................................... 219

Part III: How Stress Affects Mental Health

Chapter 25—Anxiety Disorders ................................................. 233

Chapter 30—Bereavement, Mourning, and Grief ..................... 297

Chapter 33—Relationships and Traumatic Stress ................... 329

Part IV: Treating Stress-Related Disorders

Chapter 42—Treating Depression ............................................. 439

Part V: Stress Management

Chapter 53—Stressful Situations: Tips for Coping ................... 527

Chapter 54—Other Stress Management Strategies ................. 553

Chapter 55—Stress Management for Children, Teens,

Chapter 56—Managing Stress in Later Life ............................. 573

Part VI: Additional Help and Information

About This Book

How to Use This Book

About the Health Reference Series

A Note about Spelling and Style

Locating Information within the Health Reference Series

Our Advisory Board

Health Reference Series Update Policy

Introduction to Stress and

Stress is the emotional and physical strain caused by the response

Are There Different Types of Stress?

in the past; and having trouble remembering the dangerous event.

What Are Some Common Myths Surrounding Stress?

Myth: Stress is the same for everyone.

Myth: Stress is always bad.

Myth: Stress is everywhere, so nothing can be done about it.

Myth: The most popular techniques for reducing stress are

Myth: No symptoms, No stress.

Myth: Only major symptoms of stress require attention.

How Does Stress Affect People?

Is Stress Experienced Differently by Genders or

 PERCENT RATING THEIR AVERAGE STRESS LEVELS AS EXTREME   OR  ON

Does Stress Look Different across Cultures?

What Are the Warning Signs of Stress?

tend to be the pressures of work, relationships, money, or family prob-

Warning Signs of Stress

s ,OSS OF SEX DRIVE

Can Stress Be Prevented?

How Can Stress Be Managed?

resilience, it also is important to be ready to deal with stress if the

Signs and Symptoms of Stress

Stress is difﬁcult for scientists to deﬁne because it is a highly subjec-

 #ONSTIPATION DIARRHEA

46. Constant tiredness, weakness, fatigue

The Effects of Stress

Figure 2.1. Parts of the body most affected by stress.

As demonstrated in the preceding list, stress can have wide ranging

Stress is an inevitable part of life. Human beings experience stress

one, a natural disaster, a frightening accident, and family disruptions

Stressful Life Events

The most common psychological and social stressors in adult life

PERCENT RATING THEIR AVERAGE STRESS LEVELS AS EXTREME OR ON

#ONSTIPATION DIARRHEA

!CCORDING TO A STUDY THAT APPEARED IN A ISSUE OF SCAN (Social