What is
Stress Illness?

A stress illness is a symptom (or symptoms) resulting from physical or psychological stress. 

Stress illness can cause pain, fatigue, depression, anxiety, nausea, dizziness, numbness, paralysis, seizure-like activity or other symptoms. Even though the origin of the symptom is stress, the manifestation of it is physical, 100% real and possibly debilitating. 

Do I Have Stress Illness?

Signs and Symptoms

Some common manifestations of stress illness are: fibromyalgia, headaches, fatigue, irritable bowel syndrome, chronic back pain, anxiety and insomnia. 

You are more likely to have a stress illness if:

  • You have had multiple medical treatments or seen multiple physicians without lasting relief

  • Your doctor doesn't know what is causing your symptoms or they give you a diagnosis but the treatment doesn't work

  • You spend a large portion of your energy trying to manage your symptoms or you worry about it frequently throughout the day

  • Your symptoms are inconsistent or have changed in quality, severity or location over time 

  • The symptom began during a stressful time in your life

  • Symptoms worsen when you are under physical or emotional stress

  • You have a diagnosis synonymous with stress illness (eg. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, conversion disorder, non-epileptic seizures, complex regional pain syndrome, multiple chemical sensitivity)

Why Haven't I Heard of Stress Illness Before?

The Invisible Pandemic

Stress illness is not taught in medical school or residency. Partly this is because it is not easily studied in a lab. The presentations are widely varied, often subjective, and difficult to measure. The etiology (stress) likewise is varied and difficult to pin down. This is not a disease that can be broken down into a molecular pathway. It is a complex interaction of environment, experiences, thoughts, feelings, and beliefs. 

Nevertheless, doctors recognize the patients with stress illness in their practice. These are the patients that physicians dread because they never seem to get better with the medical treatments they are provided. Many have long allergy lists and seem to be sensitive to every medication. Surgeries to fix pain seem to fail. Sometimes they work, but the pain returns in a totally different location.

 

The only person more frustrated that the physician is the patient.

Is Stress Illness Real?

The evidence

  • There is strong evidence for the correlation between stress illness conditions. For example, people with irritable bowel syndrome are 60-80% more likely to have migraine, fibromyalgia or depression than people without IBS (1). 

  • People with depression or anxiety are more likely to develop chronic pain conditions such as low back pain (2).

  • In countries such as Singapore where whiplash is not a part of the cultural story about car accidents, there are virtually no reported cases of chronic neck pain after a car accident (3). 

  • There are correlations between adverse childhood events (such as physical, emotional or sexual abuse) and stress illness such as fibromyalgia (4).

  • Acute and chronic stress affect every system in your body (5) which explains the broad scope of stress illness symptoms.

(1) bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-6-26 

(2) pubmed.ncbi.nlm.nih.gov/20735749/

(3) ard.bmj.com/content/58/1/1

(4) www.ncbi.nlm.nih.gov/pmc/articles/PMC5045103/

(5) www.apa.org/topics/stress/body#:~:text=Musculoskeletal,tension%20when%20the%20stress%20passes.

How Does Stress Illness Work?

The Mechanism

Most symptoms of stress illness tend to fall into at least one of the following categories: 

  1. Danger signals

  2. Overactive stress response

  3. Physical expression of unconscious emotion 

  4. The unconscious ally

As you read through the description of each category, keep in mind that you may need to address all four categories or just one or two. 

No matter which type you experience, all stress illness symptoms are ultimately designed to protect us. They often help us escape from a stressful situation or acquire social support. They may alert us to self-harming behaviors (eg. overwork) or act as an outlet for repressed emotions. Below, you will find a description of each and suggestions for treatments. 

Danger Signals

Symptom Type #1

A danger signal is a sensation designed to modify our behavior to keep us safe. They accomplish this by being uncomfortable and difficult to ignore. Pain, fatigue, dizziness, breathlessness, irritation, itching and nausea all fall into this category. When we feel these unpleasant symptoms, we tend to blame the part of the body that feels bad. However, these danger signals are strongly modified by the interpretation of the brain. When the brain perceives danger, it can cause excruciating pain even in the absence of injury. When it perceives safety, it can turn down the pain dial to zero even in the setting of a physical injury. The same is true of all danger signals. 

In stress illness, the brain perceives danger in the absence of (or out of proportion to) a physical trigger. This is called central sensitization and it causes pain or other danger signals to become persistent and resistant to conventional medical treatments including medication, physical therapy and surgery. Of the three of these, surgery is the strongest placebo and often causes the pain to improve temporarily or move to a different part of the body altogether. The severity of symptoms caused by stress illness range from mild to severe and debilitating. 

Anxiety almost always accompanies this type of stress illness. The physical symptoms and anxiety have the same root (the perception of danger). They also feed off of each other. As the symptom worsens, the anxiety worsens and as the anxiety worsens, the symptom worsens in a vicious positive feedback loop.

The treatment for danger signal type symptoms is cognitive behavioral therapy and pain reprocessing therapy. These therapies focus on teaching your brain that it is safe so that it turns down the pain sensitivity dial. A great resource for this sort of treatment is the book The Way Out by Alan Gordon or the Unlearn Your Pain Workbook by Howard Schubiner. You can also listen to the Tell Me About Your Pain Podcast or download the Curable app. 

Some people who are only dealing with this first type of stress illness can recover dramatically in a very short amount of time. For some, just learning that their symptom is mind-body in origin is enough to alleviate the anxiety which heals the symptom.

Overactive Stress Response

Symptom Type #2

Another type of symptom caused by stress illness is a result of the stress response itself. The stress response is mediated by the autonomic nervous system and comes in two flavors. Sympathetic (fight-or-flight) and parasympathetic (freeze).

Sympathetic (fight or flight): When stuck in the sympathetic stress response, you may experience anxiety, panic attacks, heart palpitations, muscle tension, indigestion or insomnia.

 

Parasympathetic (Freeze): When stuck in the parasympathetic stress response, you may experience fatigue, depression, helplessness, brain fog, amnesia, dissociation, numbness or paralysis. 

When the autonomic nervous system is out of balance, we often experience both of these extremes. The treatment for a hyperactive stress response includes the following steps:

1. Identify the original source of stress and eliminate it

The original source of stress is often chronic. You may have lived with it for a long time before a more acute source of stress tipped your nervous system over the edge into overwhelm. Examples include: an abusive relationship, an eating disorder, undiagnosed celiac disease, poorly controlled diabetes, severe isolation or loneliness or any other long-term physical or emotional stressor. Type #1 stress illness (danger signals such as chronic pain) can act as the original stressor leading to this type #2.

2. Identify secondary sources of stress and minimize them

Once our autonomic nervous system becomes overwhelmed it begins to overreact to the normal stresses of everyday life. It can begin to perceive safe stimuli as unsafe. Examples of these secondary stressors include: fasting (even for just a few hours), scents, electromagnetic fields, loud noises, crowded environments, leaving home, work or school demands, or any other stimuli which the nervous system interprets as a threat. You will know these are stressors for you when they make your symptoms flair up.

3. Return to homeostasis through completing the stress response

See the next section for details on how to do this.

4. Slowly reintroduce secondary sources of stress as tolerated

When your nervous system is able to feel safe and relaxed, it can regain resilience. Reintroduce stressors slowly as it recovers. Continue to avoid the original stressor. 

Completing the Stress Response

Here are some strategies for completing the stress response:

1. The Tremor Reflex

  • The tremor reflex is an involuntary trembling or shaking that releases built up muscle tension. Human beings, specifically adults, tend to suppress this reflex which prevents the nervous system from being able to discharge tension so that it can return to a relaxed state.

  • You can go here to read more about the reflex and see examples of exercises that help you relearn it. I also recommend the book Waking the Tiger by Peter Levine. 

2. Emotional release

  • Energy is also released emotionally via crying and other expressions of strong emotions (eg. yelling) 

  • Set aside time for feeling and expressing emotions that were placed on the back burner during the day. This can be done privately or in the presence of a supportive friend or partner.

  • Notice that this is different from rumination which is a process of thinking, not feeling. Emotional release involves very little thinking or verbal processing at all. The attention is in the body rather than the mind.

3. Visualization + Exercise

  • Exercise, especially coupled with visualization, can provide the adrenaline rush needed to complete the stress response.

  • I recommend vividly imagining yourself taking physical action (ie fighting or running) in a prior stressful situation (especially one where you froze or it was socially unacceptable to take physical action). This simulates completing the stress response at that moment.

  • Many times our minds will try to do this automatically. Have you ever had violent impulses towards a coworker, boss, family member or stranger after having an altercation or interaction in which you felt threatened (either personally or on behalf of another)? If so, these thoughts might have troubled you. Maybe you pushed them away. If so, you were suppressing your body's natural mechanism for discharging stress. Allowing those fantasies full reign in your mind, especially while exercising, can help you to return to a state of calm and safety.

  • You can read more about this in the first chapter of Burnout by Amelia and Emily Nagoski.

Expressions of Unconscious Emotions

Symptom Type #3

Some stress illness symptoms are related to unconscious emotions. The most useful framework I have found for understanding this phenomenon is Internal Family Systems Therapy (IFS) which invites us to think of the mind as a system of multiple different Parts, each with their own inner life, motivations and emotions.

 

Exiles: Some parts may be deeply wounded and have emotions that threaten to overwhelm the system. Other parts may have needs or emotions that got us in trouble as children and so are seen by the system as "bad." These rejected parts are called exiles.

 

Protectors: In order to protect the system, other parts (Protectors) quarantine the Exiles away from conscious experience. 

Stress illness symptoms may be caused either by Exiles trying to get your attention or they may be caused by Protectors trying to distract attention away from Exiles who might otherwise enter into conscious awareness.

I have seen several patients who have non-epileptic seizures (they black out and go into convulsions but have normal brainwave patterns on EEG) while going through what appear to me to be very stressful events (such as the death of a loved one) but they will tell me they don't feel stressed out at all. I have seen another patient who periodically loses control of her limbs as they flail about. This first started happening after a severe episode of depression and has been going on for decades though she denies any depression since they started. These are probably examples of Exiles trying to get attention.

I have seen other patients obsess over their symptoms, often pain. They can't seem to give their attention to anything else. They have often dealt with distressing symptoms since childhood and have a history of childhood  abuse or trauma. These are more likely examples of Protectors distracting from Exiles. 

Patients with this type of stress illness are more likely to have a diagnosis of a personality disorder (such as borderline) and/or complex PTSD. 

The best treatment for this type of stress illness is IFS therapy, EMDR (eye movement desensitization and reprocessing) therapy or other types of trauma-informed therapy. You can also try the Journal Speak method if it is not overwhelming for you to start to dig into those emotions on your own. You can check out this blog to learn about how journaling helped the author recover from chronic back pain. It is always a good idea to work on the category #1 and #2 treatments as well which can be very helpful and safer than digging into the root causes of #3 without a therapist. 

The Unconscious Ally

Symptom Type #4

There is also a 4th type of stress illness symptom which does not necessarily overlap with the other three. I call this the Unconscious Ally type because it is characterized by a symptom which helps us to get our needs met. These needs tend to be ones which we either suppress or have tried and failed to get met in conscious ways. Here are some examples:

  • You get weak and collapse whenever your partner becomes upset and starts yelling at you. 

  • You are being pushed harder and harder at your office job by a critical boss. You notice that your typing skills gradually get worse until you are no longer able to perform your duties and you are laid off. You find that your typing skills come back when you start a new job that is more supportive and appreciative. 

  • You have suffered a whiplash injury in a motor vehicle accident and are seeking compensation in court for your pain and medical bills. 

  • You seem to get a migraine every time you make plans to visit your critical mother-in-law.

Notice that some of these gains are obvious (such as a financial incentive) but others may be unconscious and seem contrary to your goals (symptoms that sabotage your ability to work in an abusive job). 

The best treatment for this #4 type of stress illness symptom is education and to address the root need that is not being met.

As you can see, stress illness is complex and can vary greatly from person to person, both in cause and presentation. I suspect that every American experiences physical symptoms related to stress but very few recognize it. Our medical system is woefully unprepared to handle these issues, despite how commonly we see them in practice. Physicians focus on physical causes and most consider symptoms caused by stress to be outside their scope of practice. Medical school does not encourage us to consider stress-illness as a possible cause, much less give us education on treatments. Psychologists, on the other hand, are rarely trained to consider physical symptoms at all. Except for the rare psychological practitioners who work with chronic pain, there is a gaping hole in our healthcare system for anyone with stress illness symptoms. It is my goal to help mend this hole.

 

Please note that I have no formal training in stress illness diagnosis or treatment. Indeed, I know of no formal training being offered on stress illness as a whole. I do plan to seek further training on treatments such as EMDR and biofeedback as funds become available, but for now I come only with the tools I gleaned from healing myself, treating a handful of other patients during residency and learning from books. I am still a novice in training. If you come to me for treatment of a stress illness disorder you will be my teacher as much as my patient.