By Lawson R. Wulsin
University of Cincinnati
COVID-19 has taught most people that the line between tolerable and toxic stress—defined as persistent demands leading to illness—varies widely. But some people will age faster and die younger from toxic stressors than others.
So how much stress is too much and what can you do about it?
Toxic stress increases the risks of obesity, diabetes, depression and other diseases. (Photo by Klaus Vedfelt/Digital Vision, Getty Images, via The Conversation)
I am a psychiatrist specializing in psychosomatic medicine, which is the study and treatment of people who have physical and mental illnesses. My research focuses on people who have psychological conditions and medical conditions, as well as those whose stress exacerbates their health problems.
I have spent my career studying mind-body issues and training physicians to treat mental illness in primary care settings. My upcoming book is titled Toxic Stress: How Stress is Killing Us and What We Can Do About It.
A 2023 study of stress and aging across the lifespan—one of the first studies to confirm this common wisdom—found that all four measures of stress accelerate the pace of biological aging in middle age. He also found that persistent high stress ages people in a way comparable to the effects of smoking and low socioeconomic status, two well-established risk factors for accelerated aging.
The difference between good stress and the toxic kind
Good stress – a demand or challenge that you can handle easily – is good for your health. In fact, the rhythm of these daily challenges, including eating, cleaning up, interacting with each other, and doing your job, helps regulate your stress response system and keep you fit.
Toxic stress, on the other hand, depletes your stress response system in ways that have long-lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestseller, The Body Keeps Score.
The earliest effects of toxic stress are often persistent symptoms such as headaches, fatigue, or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown disease with a life of its own can emerge – such as migraine headaches, asthma, diabetes or ulcerative colitis.
When we’re healthy, our stress response systems are like an orchestra of organs that miraculously tune up and play in unison without our conscious effort—a process called self-regulation. But when we’re sick, some parts of this orchestra struggle to regulate, causing a cascade of stress-related dysregulation that contributes to other conditions.
For example, in the case of diabetes, the hormonal system struggles to regulate sugar. In obesity, the metabolic system has difficulty regulating energy intake and consumption. In depression, the central nervous system develops an imbalance in its circuits and neurotransmitters, making it difficult to regulate mood, thoughts, and behavior.
“Treatment” of stress
Although stress neuroscience in recent years has given researchers like me new ways to measure and understand stress, you may have noticed that in your doctor’s office, stress management is usually not part of your treatment plan.
Most doctors don’t appreciate the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease, and obesity, in part because stress is difficult to measure and in part because it is difficult to treat. Basically, doctors don’t treat what they can’t measure.
The neuroscience and epidemiology of stress have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife increase dramatically when people are exposed to trauma or adverse events, especially during vulnerable periods such as childhood.
Over the past 40 years in the U.S., alarming increases in rates of diabetes, obesity, depression, PTSD, suicide, and addiction point to one contributing factor these disparate diseases share: toxic stress.
Toxic stress increases the risk of onset, progression, complications or early death from these diseases.
Sufferers of toxic stress
Because the definition of toxic stress varies from person to person, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to four or more adverse events in childhood. This is the threshold for higher disease risk in adulthood.
Research from before the COVID-19 pandemic also shows that about 19% of US adults have four or more chronic conditions. If you have even one chronic illness, you can imagine how stressful four must be.
And about 12% of the US population lives in poverty, the epitome of a life where needs exceed resources every day. For example, if a person doesn’t know how they’re going to get to work each day, or has no way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats can keep them on high alert or shut them down in a way that prevents them from trying to cope at all.
Add to these overlapping groups all those struggling with abusive relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods, or working in or around noise or polluted air. It seems conservative to estimate that about 20% of people in the US are living with the effects of toxic stress.
Recognizing and managing stress and related conditions
The first step to managing stress is to recognize it and talk to your primary care physician about it. The clinician may conduct an assessment that includes a self-reported measure of stress.
The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, called “lifestyle medicine,” focuses on improving health outcomes by changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate.
Adopting these lifestyle changes isn’t quick or easy, but it works.
The National Diabetes Prevention Program, the Ornish “UnDo” program for heart disease, and the US Department of Veterans Affairs PTSD program, for example, all achieve delays or reversals of stress-related chronic conditions through weekly support groups and guided daily practice from six to nine months. These programs help people learn how to practice personal regimens of stress management, diet, and exercise in ways that build and maintain their new habits.
There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. Next steps include finding ways to expand recognition of toxic stress and, for those affected, to expand access to these new and effective treatment approaches.
Lawson R. Ulsin is a professor of psychiatry and family medicine at the University of Cincinnati. This article is republished from The Conversation under a Creative Commons license. Read the original article.