Understanding Stress: from natural reaction to chronic risk

Confusion between stress and trauma-related disorders often arises because they share some symptoms, such as anxiety, avoidance and emotional fatigue. However, it is important to understand that, although they may appear similar on the surface, they have distinct origins, duration and clinical implications. Stress is an adaptive response of the body to external or internal demands, which may be acute or chronic, but generally subsides when the stressful situation is resolved.

By Alexandra Zareth

In contrast, trauma-related disorders-such as post-traumatic stress disorder (PTSD)-are triggered by profoundly shocking or threatening events, and their effects may persist for months or years, even if the danger is no longer present. People with traumatic disorders may experience flashbacks, nightmares, hypervigilance, and significant impairment in daily functioning.

Understanding these differences is key to avoiding misdiagnosis and providing appropriate treatment for each case.

Shall we understand what stress is?

Stress is a physiological and psychological reaction that is activated when the brain detects a threat. In this process, the body releases hormones such as cortisol and adrenaline, preparing us for a “fight or flight” response. This response was key to survival in our ancestors, but in the modern world, it is often triggered by non-life threatening factors such as traffic, work problems or personal conflicts.

In recent years, the importance of caring for caregivers has been rising to the surface. Individuals who serve the community in emergency settings are caregivers who are continuously exposed to clients, stories, and conditions that highlight issues of poverty, abuse, pain, loss, anger, and other tragic aspects of life.

Research has unveiled the negative impact trauma work has on caregivers, which includes individuals in relief work, mental health professionals, as well as medical and police personnel. It has been found that there is higher emotional exhaustion for emergency department staff and emergency medical services providers, nurses, social workers, and military veterans  than the average person.

While there is a general acceptance of such insights, a scarcity of research remains as it pertains to the effects of trauma exposure on individual’s closest personal relationships, studies are needed to extrapolate themes that care providers identify when discussing dynamics about their primary significant relationship. But as those are still being looked into, let us begin by understanding how stress lives in our bodies and what might happen when either our natural systems misfire, stress compiles, and/or we pick up and carry other’s stress for an extended period of time.

The American Psychological Association categorizes stress-related conditions as Trauma- and Stressor-Related Disorders. These disorders are characterized by exposure to a traumatic or stressful event, leading to a range of psychological symptoms. The manual provides specific criteria for diagnosing these conditions, ensuring that clinicians can accurately identify and treat individuals affected by trauma and stress. While trauma and stress might be present in people and part of the symptoms we as clinicians use to diagnose, there are important differences and definitions that we should clarify in order to fully understand them and empower ourselves with the information we need to seek healing and wellness.

Stress is a natural reaction in our bodies when we encounter a real or perceived threat or demand. Stress causes physiological reactions in our bodies because hormones (cortisol, adrenaline and norepinephrine) increase heart rates, breathing, sweating and heighten alertness. We can all imagine this is helpful in emergencies but problems arise when our systems go into “overdrive” and there is not an emergency to respond to. Stress can also carry with it psychological and emotional impact such as anxiety, frustration, anger, worry, difficulty with concentration, memory, and decision making.

It is known as “acute” when it is short lived and in response to a specific event (i.e., a specific exam, an almost-accident). It can be episodic such as related to public speaking; it can be chronic such as living with a debilitating disease and facing ongoing financial difficulties. Stress and anxiety might feel similar but if threats are  no longer present and tension and pressures persist, then that is anxiety fueled by fears. Trauma, on the other hand, I find it helpful to describe trauma as “too much too fast” - or moments when there are not enough internal resources in a person to meet the needs when certain things happen to people.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), trauma-related disorders differ from general stress in that they stem from exposure to life-threatening, violent, or overwhelmingly distressing events. These disorders affect not only emotional well-being but also how a person thinks, functions, and relates to others. One of the most well-known conditions is Post-Traumatic Stress Disorder (PTSD), which can occur after direct or indirect exposure to trauma, such as combat, assault, or natural disasters. Symptoms include flashbacks, nightmares, emotional numbness, and hypervigilance, lasting more than a month and significantly disrupting daily life.

Another related condition is Acute Stress Disorder (ASD), which involves similar symptoms to PTSD but occurs within the first month after the trauma. If symptoms persist beyond that, a diagnosis of PTSD may be considered. There is also Adjustment Disorder, which is a stress response to significant life changes like divorce, job loss, or illness. Unlike PTSD or ASD, the stressor in Adjustment Disorder does not have to be life-threatening, but it still leads to emotional or behavioral disturbances that impact functioning.

Professionals who work closely with trauma survivors — such as therapists, nurses, or first responders — may experience Secondary Traumatic Stress (STS) or Vicarious Trauma. STS mirrors PTSD symptoms and can result from hearing about others’ traumatic experiences. Vicarious trauma, on the other hand, is more about cumulative exposure and often leads to deeper shifts in worldview, such as a loss of trust, safety, or meaning. While STS can be diagnosed as PTSD if the full criteria are met, vicarious trauma is not formally recognized in the DSM-5 but is still an important concept in clinical and occupational health settings.

The confusion between stress and trauma-related disorders often arises because they share some symptoms, such as anxiety, avoidance, and emotional fatigue. However, the intensity, duration, and cause of the symptoms are what distinguish everyday stress from diagnosable conditions. Recognizing this difference is critical, especially when emotional distress begins to interfere with one’s ability to live, work, or maintain relationships.

What could cause an episode of stress?

The causes of stress can vary widely among individuals, but some of the most common include:

Types of Stress

There are different forms of stress, which vary according to their duration and intensity:

• Acute stress: it is of short duration and generally arises from a punctual challenge. It usually disappears once the situation is overcome.

• Episodic acute stress: It occurs on a recurrent basis. People with this type of stress live in constant tension.

• Chronic stress: It is continuous and persistent. It may be due to prolonged problems such as unemployment, a bad relationship or adverse working conditions. It is the most harmful to health.

Stress in Health Care Workers

During the last few years, especially after the pandemic, the impact of stress on physicians, nurses and other healthcare workers has become more visible. Emotional exhaustion, depersonalization and a sense of ineffectiveness are characteristics of burnout syndrome, which is very common in this sector.

It is vital that institutions implement emotional support measures, reasonable shifts, adequate rest spaces and mental health programs to protect their workers.

Stress is a normal response of the body, but when it becomes chronic, it can become a silent enemy. Recognizing its causes, symptoms and consequences is the first step in managing it. Whether in everyday life or in demanding professions such as medicine, learning to manage stress is essential to take care of our health and well-being.

How to Manage Stress

Some effective strategies to reduce stress include:

• Breathing and meditation techniques

• Regular physical exercise

• Organization and time management

• Social support and psychotherapy

• Adequate rest and good nutrition

If you need help managing the stress in your life, please seek help. 

The Zoe Network has a team of professionals that can support you on your journey and we also have resources to help you manage your stress better. We are at your service. 

www.alexandrazareth.com