Chronic Stress: It's Not Just in Your Mind

MARCH 20, 2017
Kathleen Kenny, PharmD, RPh
Stress comes in many forms and can be the result of numerous factors. It can be positive, neutral, or negative. External forces that can cause stress include those in the physical environment—such as relationships, home matters, and personal and work-related challenges and expectations—while internal factors include worrying excessively and having irrational, pessimistic thoughts. Internal factors also determine an individual’s ability to handle stress. These include nutritional status, overall health/fitness level, emotional well-being, sleep/rest, personality traits, and cultural views.1
When stress is within an individual’s comfort zone, it can help maintain focus, energy, and alertness. In emergency situations, it can prepare an individual for the fight-or-flight response and save a life. Beyond the comfort zone, however, stress stops being helpful and can cause physical and mental problems. The human body does not distinguish between daily stress and life-threatening situations very easily. Therefore, chronic stress can evoke the fight-or-flight response on a daily basis, which can lead to serious health problems.2 Constant stress that persists over an extended amount of time can be physically and psychologically debilitating.3
Signs and Symptoms
Symptoms can manifest in nearly every system in the body and can range from mild to severe in each system. Table 12 lists some symptoms of chronic stress.2

Stress and Hormones
Hormone levels change in response to stress. Glucocorticoids, catecholamines, growth hormone, and prolactin all increase. Table 2 lists hormones affected by stress.4 Some of these hormones are required for the fight-or-flight response, while other responses to stress can lead to heart disease, gonadal dysfunction, obesity, and endocrine disorders.
Table 2. Hormones Affected by Stress and Their Actions
Cortisol Primes the body for mobilization
Catecholamines Increases: cardiac output, skeletal muscle blood flow, sodium retention, glucose level, bronchodilation, behavioral activation
Reduces: intestinal motility, cutaneous vasoconstriction
Vasopressin Stimulates secretion of adrenocorticotropin
Gonadotropins Suppresses gonadotropins
Thyroid hormones Decreases T3 and T4 levels
Growth hormone Can increase up to 10-fold with psychosocial stress, but is rarely changed in psychological stress
Prolactin Increases or decreases depending on the local regulatory environment
Insulin Decreases
Adapted from reference 4.
Effects of Chronic Stress on the Body
Sudden stress causes the body’s muscles to tense and prepare for action. During chronic stress, the muscles are generally in a constant state of guardedness. This may trigger stress-related disorders, such as tension-type headache or migraine headache, both of which are associated with chronic tension of the neck, head, and shoulders.5 Stress increases heartrate and the strength of contractions of the heart muscle. Chronic stress may contribute to long-term heart and blood vessel problems, thereby increasing the risk for hypertension, heart attack, and stroke.5
During times of stress, the hypothalamus signals the autonomic nervous system and the pituitary gland to produce epinephrine and cortisol, also known as the stress hormones, which cause the liver to produce more glucose. This can lead to diabetes in individuals who maintain a high glucose level.5
Overeating, undereating, and self-medicating with alcohol or tobacco are common during stressful times. Combined with chronic stress they can cause acid reflux, ulcers, or severe stomach pain (even without ulcers). In addition, stress can affect the digestive system, causing constipation or diarrhea.5
Chronic stress can be a long-term drain on the body. Persistent activation of the sympathetic nervous system causes the entire body to run down, including the immune system. This increases susceptibility to allergies, infections, and autoimmune diseases.6 Further, stress can aggravate acne, psoriasis, and eczema, and has been linked to unexplained, itchy skin rashes.6
In males, chronic stress can affect testosterone production and sperm production and maturity, and cause erectile dysfunction.5 In females, menstrual cycles may become irregular or nonexistent, more painful, or shorter or longer; PMS may become worse or more difficult to manage; and sexual desire may decrease.5
Stress Management
Although individuals may not be able change their situations, they can take steps to manage their stress. Eating a healthy diet, exercising regular, and getting plenty of sleep can strengthen the body and mind to better handle stressful situations.7 Relaxation techniques, such as yoga, deep breathing, and meditation require practice, but once mastered, they can provide an outlet for stress and the mindfulness to learn to cope with stressors.7 Other ways to manage stress include taking time for a hobby, fostering healthy friendships, having a sense of humor, volunteering, and seeking professional counseling when needed.7
Dr. Kenny earned her doctoral degree from the University of Colorado Health Sciences Center. She has 20+ years’ experience as a community pharmacist and works as a clinical medical writer based out of Colorado Springs, Colorado. Dr. Kenny is also the Colorado Education Director for the Rocky Mountain Chapter of the American Medical Writer’s Association and a regular contributor to Pharmacy Times®.

  1. Stöppler MC. Stress: facts on symptoms and stress management. MedicineNet website. Accessed November 14, 2016.
  2. Segal J, Smith M, Segal R, Robinson L. Stress symptoms, signs, and causes: the harmful effects of stress and what you can do about it. website. Accessed November 11, 2016.
  3. Alvord MK, Davidson KW, Kelly JF, McGuiness KM, Tovian S. Understanding chronic stress. American Psychological Association website. Accessed October 14, 2016.
  4. Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011;15(1):18-22. doi: 10.4103/2230-8210.77573.
  5. Tovian S, Thorn B, Coons H, et al. Stress effects on the body. American Psychological Association website. Accessed November 14, 2016.
  6. Collingwood J. The physical effects of long-term stress. PsychCentral website. Accessed November 14, 2016.
  7. Mayo Clinic Staff. Stress management: examine your stress reaction. Mayo Clinic website. Accessed November 14, 2016.


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