Summary Stress-Related Disorders
Biomedical Sciences Master Course
Radboud University, Nijmegen
Made by: Georgia Graat
,The stress process
Stress is part of our everyday life and in most cases we effectively cope with such challenges.
However, in some individuals and conditions, stress can pose a risk for the brain and our health,
especially when the stress is severe, recurrent, chronic, or occurs at an early age. The long-term
consequences of stress depend on a complex interplay between genes and environment that
ultimately determines vulnerability or resilience to psychopathology. Stress is the body’s natural
defense against predators and danger. It flushes the body with hormones to prepare systems to
evade or confront danger, known as the fight-or-flight mechanism. Stress is the psychological,
physiological, and behavioral response by an individual when they perceive a lack of equilibrium
between the demand placed on them and their ability to meet those demands, which over a period
of time leads to ill health. Stress is always characterized by unpredictability and uncontrollability.
There are three types of reactions coming into play during stress:
1. Physical
a. Sweating, pain, cramps, fainting, headache, heart disease, higher blood pressure,
lower immunity, sleeping difficulties, and loss of libido
2. Behavioral
a. Food cravings and eating too much/little, anger outbursts, drug and alcohol abuse,
higher tobacco use, social withdrawal, frequent crying, and relationship problems
3. Emotional
a. Anger, anxiety, burnout, concentration, depression, fatigue, insecurity, forgetfulness,
irritability, and sadness
The stress is always the health outcome we see. It all
starts with a stressor. A stressor is an internal or external
stimulus or event that threatens the homeostasis of an
organism, either physiological or psychological. The
stressor is characterized by frequency, severity, and
duration. Examples are disease, environmental stress,
trauma, significant life events, accidents, internal stress by
memory or emotions, relation, work, bullying, private life
stress, social and low social support and discrimination.
This stressor is processed by the body and leads to a certain response. The stress outcome always
depends on the processing and adaptation. Processing is how the stressor is viewed and how the
person handles this. It depends on the perception, individual characteristics, appraisal, coping
mechanism, social support, and defense mechanisms. Coping is the concept of handling stressors, by
investing conscious effort to solve personal and interpersonal problems, in order to try to master,
minimize or tolerate stress and conflict. There are several coping strategies/skills. The effectiveness
of this coping effort depends on the type of stressor, personality characteristics, and nature of the
stressful environment.
- Cognitive coping
o Cognitive approach coping → logical analysis, positive reappraisal, accepting reality,
and restructuring
o Cognitive avoidance coping → denying or minimizing the stressor and its
consequences, and accepting a situation
- Behavioral coping
o Behavioral approach coping → taking concrete action, and seeking support
, o Behavioral avoidance coping → seeking alternative rewards, starting behaviors that
temporarily reduce tension, and taking substances
- Emotion focused coping
o Emotion regulation → management of emotional reactions
Most people return to homeostasis so they recover well from the stressor, while some people show
increased vulnerability. These people will get ill health outcomes much sooner which in stress shows
itself as chronic stress, physical and mental ill health, and death. Psychiatric disorders often arise
when an individual cannot handle the stress. The existing mental disorders are: acute stress disorder,
adjustment disorder, addiction, brief reactive psychosis, bulimia nervosa, depressive disorder,
intermittent explosive disorder, panic disorder, post-traumatic stress disorder, premenstrual
dysphoric disorder, schizophrenia, separation anxiety, social anxiety, and somatic symptom disorder.
The WHO classifies mental health as a state of well-being, in which every individual realizes his own
potential, can cope with the normal stresses of life, can work productively, and contributes to the
community. The DSM-5 says that a mental disorder is a syndrome characterized by clinically
significant disturbances in an individual's cognition, emotion regulation, or behavior that reflects a
dysfunction in the physiological, biological, or developmental processes underlying mental
functioning. A mental disorder is a condition associated with significant distress or disability in social,
occupational, or other important activities. All psychiatric disorders are caused by a dysregulation of
stress processes. Automatic body processes and brain processes are often disrupted.
Genetic factors almost always give a predisposing vulnerability to the development of the disease,
certain environmental risk factors, and the interaction with those factors. Environmental factors are
usually the actual cause of the disease. These factors can be biological (neglect, violence, brain injury,
infection, malnutrition, substance misuse), social (low social class, discrimination, social network) or
psychological (parental loss, bullying, traumatic events, work environment, abuse). Mental disorders
show a large overlap between risk factors and symptoms.
The neurobiology of the stress process knows 7 steps. There
are always three acting systems in the body: the nervous
system, the endocrine system, and the immune system. The
nervous system produces neurotransmitters and causes the
brain and body to react in a certain way. The endocrine system
is needed in hormone production with similar effects to the
nervous system. The immune system sends cytokines during
the stress response. These three systems always interact.
1. Processing in the limbic system
2. HPA axis
3. Limbic cortical system ventral and dorsal
4. Stress process: acute phase
5. Stress process: chronic phase
6. Interaction sympathetic nervous system and HPA axis
7. Interaction immune system and HPA axis
Stress starts in the limbic system. The amygdala, hippocampus, thalamus, and hypothalamus work
together to make a memory on what the trigger means, and make a connection with the prefrontal
cortex that controls the automatic reactions. Neurotransmitters are important in this system.
