8.3 Stress and Disease

Stress as a Response

Stress is generally considered an event or factor that acts on a person, but it can be both the stimulus itself and the cluster of clinical manifestations experienced as a result of the stress (MedlinePlus, 2022). For example, a patient may experience stress from an illness but then demonstrate manifestations of the response to stress as hypertension, tachycardia, diaphoresis, and other sympathetic system responses. Stress can be a response to a stressor (the stress response). When a patient is exposed to an external stressor such as a pathogen, the body responds with the inflammatory response, which stresses the body toward recovery to fight the infection. The response itself may cause disease if it does not help the body recover homeostasis.

Stress as a Transaction

The Stress Transactional Model, originated by psychologists Lazarus and Folkman (1984) and shown in Figure 8.3, states the response to stress as a transaction considers the various factors that affect a person’s response to stress. These factors include those that are personal, social, environmental, spiritual, and cultural, as well as emotional intelligence level and even educational level. An example of the variation among responses based on the transaction of these factors could be the difference between two people who spill a cup of juice. One person may consider it an annoyance and then clean it up and move forward in their day, whereas another person may become very upset and let the event destroy the entire day. The factors that came into play for the different responses may have been the age, sex, emotional level, and even the economic level of the two individuals. These are the factors that need to be considered by nurses when assessing stress levels and responses of their patients.

Figure 8.3 The Stress Transactional Model considers the effects of personal, social, environmental, spiritual, and cultural factors, as well as emotional intelligence level and even educational level as factors that affect a person’s response to stress. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Stress as a Stimulus for Disease

Stress is a very common factor that leads to disease. Disease is defined as a disorder of the structure or function of the body (Merriam-Webster Dictionary, 2022). A stressor often contributes to the disorder of normal function. When homeostasis is disrupted, the body will either respond in a healthy manner to recover from the stressor, or not. For example, when a body builder stresses muscles with heavy weights and exercise, the muscle tissues may be broken down by the stress, leading to weakness. However, when the body can recover and rebuild the torn muscle, the result is a stronger and bigger muscle. When the body cannot recover and adapt to a stressor, it may further deteriorate, and result in disease.

Stress can then be a stimulus toward disease. For example, when a person is confronted by antigens and pathogens, the stress response results in efforts to protect the body. The stress can create disease if the body is unable to fight it. An extreme example is when a patient first encounters a pathogen: without successful recovery, infection by the pathogen may lead to a further stressor known as sepsis. Conditions that correlate stress-related disorders and disease include the following (Fulda et al., 2010):

• acne
• Alzheimer disease
• anxiety disorders
• asthma
• autoimmune disorders
• back and neck pain
• cardiac dysrhythmias
• coronary heart disease
• depression, anxiety, and panic attacks
• diabetes
• dysmenorrhea
• dyspepsia (indigestion)
• eating disorders
• eczema
• erectile dysfunction
• fatigue
• fibromyalgia
• headaches
• hypertension
• immunodeficiency
• insomnia
• irritable bowel syndrome and other gastrointestinal symptoms
• insomnia and sleep disturbances
• obesity
• poor wound healing
• stroke