"Providing Whole-Person, Outside-the-Box Care"
About Stress Illness
What is stress illness?
A stress illness is a symptom (or symptoms) resulting from physical or psychological stress.
Stress illness can cause pain, fatigue, nausea, dizziness, numbness, paralysis or other symptoms. Even though the origin of the symptom is stress, the manifestation of it is physical and 100% real and can be debilitating. Stress illness can even present as objectively real symptoms such as a rash or diarrhea.
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
- 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 pain began during a stressful time in your life
- You have a diagnosis synonymous with stress illness (eg. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, conversion disorder, complex regional pain syndrome, multiple chemical sensitivity)
How does stress illness work?
Most symptoms of stress illness tend to fall into one of two buckets:
- A danger signal
- An overactive stress response
Either way, 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.
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, dry eyes, 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 a physical trigger or out of proportion to the physical trigger. This is called central sensitization and it causes pain or other danger signals to become persistent and frustratingly 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 debilitatingly severe.
Anxiety can also be thought of as a danger signal. Anxiety is a state of high alert that causes us to seek out specific dangers in our environment. Many times this can lead to seeing dangers that we would not pay much attention to if we were not feeling anxious. Health anxiety is a very common manifestation of this. The patient interprets normal physical sensations or body parts as evidence of something "wrong" or dangerous and often leads to many trips to the doctor for reassurance.
The treatment for danger signal type symptoms is cultivating a safe environment for your nervous system. Education and integrating the knowledge that your symptoms don't represent anything dangerous is the first step to cultivating this environment of safety.
The Stress Response
The other type of symptom caused by stress illness is a result of the stress response itself. The stress response 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 depression, helplessness, brain fog, amnesia, dissociation, numbness or paralysis.
These symptoms are considered totally normal when they are limited to only a few minutes, but when an individual becomes stuck in the stress response their symptoms can become chronic and debilitating.
Let us use a rabbit as an example of an animal with a healthy relationship with its stress response. Most of the time, it is in Stage 1 - Rest and Digest. It eats and sleeps and mates. If it detects danger it will move into Stage 2 - Fight or Flight. It will stand completely still and alert, using all of its senses to scan for danger (anxiety). When it sees the cat that has been stalking it, it might turn and run. Or, if it has not means of escape, try to fight. If it is caught and can no longer successfully fight or flight it will move into Stage 3 - Freeze. It will lay still and play dead. Its heart rate and breathing will slow in imitation of death. If, at that moment, the cat gets picked up by its owner and taken back inside, the rabbit may lie very still for several minutes. Then, after a time, it will suddenly spring into action, kicking and flailing to get back to its feet and run away (Stage 2) before hiding in a safe spot and slowly returning to a safe and social state (Stage 1).
Completing the Stress Response
The return of the rabbit to a stage 1 Rest and Digest state from stage 3 by moving back through stage 2 is called completing the stress response. It is a necessary part of moving out of the stress response and resolving stress response symptoms. Notice that the rabbit does not have PTSD after his traumatic encounter with the cat. This is because the stress response was completed. PTSD comes as a result of an uncompleted stress response. When the stress response does not get completed, the event becomes trapped in the body and the brain interprets the event as being ever-present and imminently dangerous. Thus the symptoms of hyperarousal and flashbacks are sustained.
There are many reasons that someone might become stuck in the stress response:
- Chronic stress turns the state of fight of flight into a habit
- There was no opportunity to take action (fight or flight) during the traumatic event
- The fight/flight response was repressed, often for social reasons (you can't hit your verbally abusive customers)
Wild animals move in and out of the stress response multiple times per day and you should work to complete the stress response on a daily basis as well. Here are some strategies for completing the stress response:
- Observe the natural tendencies of your body. Animals complete the stress response through instinct but humans often suppress it. The release of stress often manifests as involuntary spasms or movements. If you find yourself having these physical manifestations of release, allow them to come naturally and don't resist or distract yourself. Observe your body with curiosity and calm acceptance.
- Energy is also released in other ways such as crying and feeling strong emotions along with their corresponding physical sensations. Set aside time for feeling and expressing emotions that were placed on the back burner during the day. (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.)
- It's likely that you have repressed emotional energy related to past events, not just today's stress. Encourage the processing of these memories through journaling. Write about them in a raw, unfiltered way and then discard the writings. It takes a while to get into this state so write for at least 20 minutes. You will know when you've struck a nerve. I recommend the Journal Speak method for this purpose.
- Adrenaline coupled with action is a fantastic way to complete the stress response. Running or fighting when your life, or the life of someone else, is on the line is sure to allow a satisfying completion of the stress response. Back when we lived among predators we had opportunities for adrenaline + action frequently but now it is more difficult to find genuine life-or-death experiences that allow a true use of the fight-or-flight response. The action needed here is physical - running, fighting, throwing, grabbing, chest compressions, etc. - not writing an angry letter or giving your neighbor a piece of your mind. It needs to be visceral and it needs to be in the setting of an adrenaline rush. In the absence of this experience in the wild, it can be replicated through exercise and imagination. The vigorous physical activity releases adrenaline and puts it to use. It also causes a trigger of the relaxation response when the activity is over. This is usually enough to release the day's pent-up stress energy but it can be augmented through the aid of imagination. By vividly imagining yourself taking physical action in a prior stressful situation (especially one where you froze or it was socially unacceptable to take physical action) you allow your body to replicate 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.
Other Names for Stress Illness
Stress illness has also been called:
- Tension myositis syndrome (TMS)
- Neuroplastic disorder
- Psychophysiologic disorder (PPD)
- Mind-body syndrome
- Medically unexplained symptoms
- Multiple unexplained physical symptoms (MUPS)
- Psychosomatic disorder
None of these labels are entirely accurate and many are misleading or stigmatizing. "Psychosomatic" for example, suggests that the physical (somatic) symptoms have their origin in emotional stress (the psyche), but this is not always true. Often, there is also an aspect of physical stress. The stress response does not distinguish between psychological stress and physical stress, it reacts the same way to both.
There are some symptoms and medical diagnoses that are well known to be stress illnesses. Other symptoms can be caused by either a structural problem or a stress illness. In my opinion, since all physical sensations are modified by the perceptions of the brain, all symptoms can benefit from mind-body work even when there is a known structural cause.
Common diagnoses for stress illness:
- Chronic fatigue syndrome
- Irritable bowel syndrome
- Conversion disorder
- Complex regional pain syndrome
- Tension headaches
- Multiple chemical sensitivity
The Most Common Stress Illness Symptoms:
- Weakness, paralysis, fatigue
- Seizure-like activity - pseudo seizures, non-epileptic seizures
- Pain - often chronic, refractory to treatment and possibly severe. The most common kinds of functional pain are back pain, headaches, pelvic pain, abdominal pain and fibromyalgia. Complex regional pain syndrome is a rare but devastating form of functional pain.
- Insomnia, restless leg syndrome, unrefreshing sleep, nightmares
- Cognitive dysfunction - poor concentration, word finding difficulty
- Loss of consciousness or memory black outs, amnesia
- Visual symptoms
- Hypersensitivity to lights, sounds, smells, and more
- Bladder symptoms - irritable or overactive bladder, urinary frequency
- Gastrointestinal symptoms - irritable bowel syndrome (IBS), heartburn, nausea, burning mouth syndrome
- Swallowing problems, slurred speech
- Jerks, twitches, tremors, involuntary movements, muscle spasms, muscle tension, teeth grinding
- Respiratory symptoms - wheezing, shortness of breath, chest pain
- Depression, anxiety, panic attacks, health anxiety, dissociation, irritability, ADHD
- Sensitivities to foods, drugs, chemicals, electromagnetic fields, changes in the weather
Stress illnesses are often associated with:
- Trauma, abuse, neglect, financial insecurity, social isolation
- Stressful work environment, insatiable boss/teacher/parent
- Living in a dangerous location such as an inner city or prison
- Adverse childhood events (ACEs)
- Intense physical activity, low caloric intake, malnutrition
- Personality traits related to "perfectionism" or high work ethic
- The tendency to reject your own needs in favor of the needs of others
- Physical stressors: viral infection, surgery, illness, car accident or other physical trauma
- Immune system dysfunction: Frequent viral or yeast infections, inflammation (redness, heat, swelling, pain), swollen lymph nodes, autoimmune disease
The pathway to healing will vary from person to person depending on the root cause of their stress illness. For some people, the root cause is gone and the only thing maintaining the symptoms is fear of the symptoms themselves. With education, these patients often heal very quickly once they understand there is no reason to be afraid anymore. For this subset of patients, you can ignore the instructions below and simply reassure yourself of your safety as you return to ordinary living. This subset of people are often characterized by the following:
- Simple symptom profile (e.g. only back pain or only IBS)
- The pain started later in life and is not attached to a history of long-term trauma or ACEs
- Pushing through the pain is painful but not associated with a prolonged flair afterwards
For others, there is still something feeding the stress response. Often, there are many things feeding it including a mixture of physical stress and emotional stress. In order to heal I suggest that you inspect both as possible sources of fuel for your stress response.
Stop Adding Fuel to the Fire
Imagine that you have been gifted a puppy. Perhaps this puppy has been rescued from an abusive home and is now afraid of everybody and everything. She is hypersensitive and easily overwhelmed. If you want to rehabilitate her you have to start by making her feel safe. You give her a warm, quiet and dark room with little stimulation. You move and speak slowly around her while hand feeding her to help her grow accustomed to your presence. You keep her fed and comfortable. You gently begin to reintroduce stressors in a way that helps her to grow new neural connections to replace the outdated ones which once helped her to survive.
Your nervous system is just like this hypersensitive puppy. You will need to find a balance between helping her to feel safe and challenging her to develop new relationships with previous stressors. Just like for the puppy, you can slowly move your nervous system out of the stress response by helping it to feel safe and then slowly reintroducing triggers. This will take time and patience. As a rule, the longer your nervous system has been on high alert, the longer it will take to heal.
In order to help your ANS feel safe, you need to first identify what your ANS is perceiving as dangerous. I call these stressors "triggers" and they are as varied as there are individuals with stress illness but I will provide some examples below. Some triggers are truly dangerous and should always be avoided (such as food allergies) but most are learned dangers that can be un-learned (exercise). Make a list of all that apply to you and which category they are in. Add your own to the list.
These triggers may cause symptom flairs immediately or may cause a flair the following day. In the case of childhood trauma, stress illness may not appear until much later in life when the patient begins to develop better self esteem along with the associated feelings of anger as he realizes he deserves better than his past (and present) circumstances. Repressed anger and other emotions are a very common source of stress illness symptoms.
- Calorie or nutrition deficit
- Low blood sugar
- Visual stimuli (lights, bright colors)
- Leaving your safe space, such as your house
- Crowded / noisy environments
- Foods (food sensitivities or allergies)
- Inflammatory diet
- Electromagnetic fields
- Weather or temperature
- Lack of sleep or rest
- Surgery, illness or injury
- Chronic disease (such as diabetes)
- Caffeine, alcohol, drugs
- Interpersonal conflict
- Repressed emotions
- Perfectionism / pressure to perform
- Financial stress
- Major life changes
- Loneliness / social isolation
- Incomplete stress response
Once you have identified your triggers, the next step is to minimize them. This may mean asking
for help, taking time off work, leaving tasks unfinished, or taking a break
from draining relationships. In the case of trauma, therapy to integrate the traumatic experience may be helpful. Many people find EMDR a very effective therapy for this purpose. For repressed emotions, I recommend a method of emotional expression called Journal Speak. I also highly recommend you work on completing the stress response daily (see above for methods of doing this).
Resources and Further Reading
The Way Out by Alan Gordon
They Can't Find Anything Wrong by David D Clarke, MD
Healing Back Pain by John Sarno
Painless: A Novel About Chronic Pain and the Mind-Body Connection by Chana Studly
The Cure for Chronic Pain with Nicole Sachs
Tell Me About Your Pain
Therapy in a Nutshell
Further Reading on Trauma
The Body Keeps the Score by Bessel van der Kolk
Waking the Tiger by Peter Levine