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Stress (biology)

Physiological or biological stress is an organism's response to a stressor such as an environmental condition. Stress is the body's
method of reacting to a condition such as a threat, challenge or physical and psychological barrier. Stimuli that alter an organism's
environment are responded to by multiple systems in the body. The autonomic nervous system and hypothalamic-pituitary-adrenal
(HPA) axis are two major systems that respond to stress.[1]

The sympathoadrenal medullary (SAM) axis may activate thefight-or-flight response through the sympathetic nervous system, which
dedicates energy to more relevant bodily systems to acute adaptation to stress, while the parasympathetic nervous system returns the
body to homeostasis. The second major physiological stress, the HPA axis regulates the release of cortisol, which influences many
bodily functions such as metabolic, psychological and immunological functions. The SAM and HPA axes are regulated by several
brain regions, including thelimbic system, prefrontal cortex, amygdala, hypothalamus, and stria terminalis.[2]

Through these mechanisms, stress can alter memory functions, reward, immune function, metabolism and susceptibility to
diseases.[3] Definitions of stress differ. One system suggests there are five types of stress labeled "acute time-limited stressors", "brief
naturalistic stressors", "stressful event sequences", "chronic stressors", and "distant stressors". An acute time-limited stressor involves
a short-term challenge, while a brief natural stressor involves an event that is normal but nevertheless challenging. A stressful event
sequence is a stressor that occurs, and then continues to yield stress into the immediate future. A chronic stressor involves exposure
to a long-term stressor, and a distant stressor is a stressor that is not immediate.

Etymology and historical usage
Biological need for equilibrium
Biological background
Biology of stress
Effects of chronic stress
Chronic disease
Psychological concepts
Cognitive appraisal
Health risk factors
General adaptation syndrome
Stage 1
Stage 2
Stage 3

History in research
See also
External links

Stress and illness may have intersecting components. Several studies indicate such a link,[5] while theories of the stress–illness link
suggest that both acute and chronic stress can cause illness, and lead to changes in behavior and in physiology. Behavioral changes
can include smoking, and changes in eating habits and physical activity. Physiological changes can include changes in sympathetic
activation or HPA activity, and immunological function.[6] However, there is much variability in the link between stress and illness.

The HPA axis regulates many bodily functions, both behavioral and physiological, through the release of glucocorticoid hormones.
The HPA axis activity varies according to the circadian rhythm, with a spike in the morning. The axis involves the release of
corticotropin releasing hormoneand vasopressin from the hypothalamus which stimulates the pituitary to secrete ACTH. ACTH may
then stimulate the adrenal glands to secrete cortisol. The HPA axis is subject to negative feedback regulation as well.[8]

The release of CRH and VP are regulated by descending glutaminergic and GABAergic pathways from the amygdala, as well as
noradrenergic projections. Increased cortisol usually acts to increase blood glucose, blood pressure, and surpasses lysosomal, and
immunological activity. Under other circumstances the activity may differ. Increased cortisol also favors habit based learning, by
favoring memory consolidation of emotional memories.

Selye demonstrated that stress decreases adaptability of an organism and proposed to describe the adaptability as a special resource,
adaptation energy.[9] One study considered adaptation energy as an internal coordinate on the "dominant path" in the model of
adaptation.[10] Stress can make the individual more susceptible to physical illnesses like the common cold.[11] Stressful events, such
as job changes, may result in insomnia, impaired sleeping, and physical and psychological health complaints.

Research indicates the type of stressor (whether it is acute or chronic) and individual characteristics such as age and physical well-
being before the onset of the stressor can combine to determine the effect of stress on an individual.[5] An individual's personality
characteristics (such as level of neuroticism),[13] genetics, and childhood experiences with major stressors and traumas[14] may also
dictate their response to stressors.[5]

Chronic stress and a lack of coping resources available or used by an individual can often lead to the development of psychological
issues such as delusions,[15] depression and anxiety (see below for further information).[16] This is particularly true regarding chronic
stressors. These are stressors that may not be as intense as an acute stressor like a natural disaster or a major accident, but they persist
over longer periods of time. These types of stressors tend to have a more negative fect
ef on health because they are sustained and thus
require the body's physiological response to occur daily

This depletes the body's energy more quickly and usually occurs over long periods of time, especially when these microstressors
cannot be avoided (i.e. stress of living in a dangerous neighborhood). See allostatic load for further discussion of the biological
process by which chronic stress may affect the body. For example, studies have found that caregivers, particularly those of dementia
patients, have higher levels of depression and slightly worse physical health than non-caregivers.

When humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses may occur.[19]
Chronic stress can include events such as caring for a spouse with dementia, or may result from brief focal events that have long term
effects, such as experiencing a sexual assault. Studies have also shown that psychological stress may directly contribute to the
disproportionately high rates of coronary heart disease morbidity and mortality and its etiologic risk factors. Specifically, acute and
chronic stress have been shown to raiseserum lipids and are associated with clinical coronary events.[20]
However, it is possible for individuals to exhibit hardiness—a term referring to the ability to be both chronically stressed and
healthy.[21] Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain
disease-free after being confronted with chronic stressful events. This suggests that there are individual differences in vulnerability to
the potential pathogenic effects of stress; individual differences in vulnerability arise due to both genetic and psychological factors. In
addition, the age at which the stress is experienced can dictate its effect on health. Research suggests chronic stress at a young age
can have lifelong effects on the biological, psychological, and behavioral responses to stress later in life.

Etymology and historical usage

The term "stress" had none of its contemporary connotations before the 1920s. It is a form of the Middle English destresse, derived
via Old French from the Latin stringere, "to draw tight".[23] The word had long been in use in physics to refer to the internal
distribution of a force exerted on a material body, resulting in strain. In the 1920s and '30s, biological and psychological circles
occasionally used the term to refer to a mental strain or to a harmful environmental agent that could cause illness.

Walter Cannon used it in 1926 to refer to external factors that disrupted what he called homeostasis.[24] But "...stress as an
explanation of lived experience is absent from both lay and expert life narratives before the 1930s".[25] Physiological stress
represents a wide range of physical responses that occur as a direct effect of a stressor causing an upset in the homeostasis of the
body. Upon immediate disruption of either psychological or physical equilibrium the body responds by stimulating the nervous,
endocrine, and immune systems. The reaction of these systems causes a number of physical changes that have both short- and long-
term effects on the body.

The Holmes and Rahe stress scale was developed as a method of assessing the risk of disease from life changes.[26] The scale lists
both positive and negative changes that elicit stress. These include things such as a major holiday or marriage, or death of a spouse
and firing from a job.

Biological need for equilibrium

Homeostasis is a concept central to the idea of stress.[27] In biology, most biochemical processes strive to maintain equilibrium
(homeostasis), a steady state that exists more as an ideal and less as an achievable condition. Environmental factors, internal or
external stimuli, continually disrupt homeostasis; an organism's present condition is a state of constant flux moving about a
homeostatic point that is that organism's optimal condition for living.[28] Factors causing an organism's condition to diverge too far
from homeostasis can be experienced as stress. A life-threatening situation such as a major physical trauma or prolonged starvation
can greatly disrupt homeostasis. On the other hand, an organism's attempt at restoring conditions back to or near homeostasis, often
consuming energy and natural resources, can also be interpreted as stress.

The ambiguity in defining this phenomenon was first recognized byHans Selye (1907–1982) in 1926. In 1951 a commentator loosely
summarized Selye's view of stress as something that " addition to being itself, was also the cause of itself, and the result of

First to use the term in a biological context, Selye continued to define stress as "the non-specific response of the body to any demand
placed upon it". As of2011 neuroscientists such asBruce McEwen and Jaap Koolhaas believe that stress, based on years of empirical
research, "should be restricted to conditions where an environmental demand exceeds the natural regulatory capacity of an

Biological background
Stress can have many profound effects on the human biological systems.[33] Biology primarily attempts to explain major concepts of
stress using a stimulus-response paradigm, broadly comparable to how a psychobiological sensory system operates. The central
nervous system (brain and spinal cord) plays a crucial role in the body's stress-related mechanisms. Whether one should interpret
these mechanisms as the body's response to a stressor or embody the act of stress itself is part of the ambiguity in defining what
exactly stress is.
The central nervous system works closely with the body's endocrine system to regulate these mechanisms. The sympathetic nervous
system becomes primarily active during astress response, regulating many of the body'sphysiological functions in ways that ought to
make an organism more adaptive to its environment. Below there follows a brief biological background of neuroanatomy and
neurochemistry and how they relate to stress.

Stress, either severe, acute stress or chronic low-grade stress may induce abnormalities in three principal regulatory systems in the
body: serotonin systems, catecholamine systems, and the hypothalamic-pituitary-adrenocorticalaxis. Aggressive behavior has also
been associated with abnormalities in these systems.

Biology of stress
The brain endocrine interactions are relevant in the translation of stress into
physiological and psychological changes. The autonomic nervous system (ANS), as
mentioned above, plays an important role in translating stress into a response. The
ANS responds reflexively to both physical stressors (for example baroreception),
and to higher level inputs from the brain.[35]

The ANS is composed of the parasympathetic nervous system and sympathetic

nervous system, two branches that are both tonically active with opposing activities.
The ANS directly innervates tissue through the postganglionic nerves, which is
controlled by preganglionic neurons originating in the intermediolateral cell column.
The ANS receives inputs from the medulla, hypothalamus, limbic system, prefrontal
cortex, midbrain and monoamine nuclei.[36]
Human brain:
The activity of the sympathetic nervous system drives what is called the "fight or hypothalamus =
amygdala =
flight" response. The fight or flight response to emergency or stress involves
hippocampus/fornix =
mydriasis, increased heart rate and force contraction, vasoconstriction, pons=
bronchodilation, glycogenolysis, gluconeogenesis, lipolysis, sweating, decreased pituitary gland=
motility of the digestive system, secretion of the epinephrine and cortisol from the
adrenal medulla, and relaxation of the bladder wall. The parasympathetic nervous
response, "rest and digest", involves return to maintaining homeostasis, and involves miosis, bronchoconstriction, increased activity
of the digestive system, and contraction of the bladder walls.[35] Complex relationships between protective and vulnerability factors
on the effect of childhood home stress on psychological illness, cardiovascular illness and adaption have been observed.[37] ANS
related mechanisms are thought to contribute to increased risk of cardiovascular disease after major stressful events

The HPA axis is a neuroendocrine system that mediates a stress response. Neurons in the hypothalamus, particularly the
paraventricular nucleus, release vasopressin and corticotropin releasing hormone, which travel through the hypophysial portal vessel
where they travel to and bind to the corticotropin-releasing hormone receptor on the anterior pituitary gland. Multiple CRH peptides
have been identified, and receptors have been identified on multiple areas of the brain, including the amygdala. CRH is the main
regulatory molecule of the release of ACTH.[39]

The secretion of ACTH into systemic circulation allows it to bind to and activate Melanocortin receptor, where it stimulates the
release of steroid hormones. Steroid hormones bind to glucocorticoid receptors in the brain, providing negative feedback by reducing
ACTH release. Some evidence supports a second long term feedback that is non-sensitive to cortisol secretion. The PVN of the
hypothalamus receives inputs from the nucleus of the solitary tract, and lamina terminalis. Through these inputs, it receives and can
respond to changes in blood..[40]

The PVN innervation from the brain stem nuclei, particularly the noradrenergic nuclei stimulate CRH release. Other regions of the
hypothalamus both directly and indirectly inhibit HP
A axis activity. Hypothalamic neurons involved in regulating ener
gy balance also
influence HPA axis activity through the release of neurotransmitters such as neuropeptide Y, which stimulates HPA axis activity.
Generally, the amygdala stimulates, and the prefrontal cortex and hippocampus attenuate, HPA axis activity; however, complex
relationships do exist between the regions.[41]
The immune system may be heavily influenced by stress. The sympathetic nervous system innervates various immunological
structures, such as bone marrow and the spleen, allowing for it to regulate immune function. The adrenergic substances released by
the sympathetic nervous system can also bind to and influence various immunological cells, further providing a connection between
the systems. The HPA axis ultimately results in the release of cortisol, which generally has immunosuppressive effects. However, the
effect of stress on the immune system is disputed, and various models have been proposed in an attempt to account for both the
supposedly "immunodeficiency" linked diseases and diseases involving hyper activation of the immune system. One model proposed
to account for this suggests a push towards an imbalance of cellular immunity(Th1) and humoral immunity(Th2). The proposed
imbalance involved hyperactivity of the Th2 system leading to some forms of immune hypersensitivity, while also increasing risk of
some illnesses associated with decreased immune system function, such as infection and

Effects of chronic stress

Chronic stress is a term sometimes used to differentiate it from acute stress. Definitions differ, and may be along the lines of
continual activation of the stress response,[42] stress that causes an allostatic shift in bodily functions,[3] or just as "prolonged
stress".[43] For example, results of one study demonstrated that individuals who reported relationship conflict lasting one month or
longer have a greater risk of developing illness and show slower wound healing. Similarly, the effects that acute stressors have on the
immune system may be increased when there is perceived stress and/or anxiety due to other events. For example, students who are
taking exams show weaker immune responses if they also report stress due to daily hassles.[44] While responses to acute stressors
typically do not impose a health burden on young, healthy individuals, chronic stress in older or unhealthy individuals may have
long-term effects that are detrimental to health.[45]

Acute time-limited stressors, or stressors that lasted less than two hours, results in an up regulation of natural immunity and down
regulation of specific immunity. This type of stress saw in increase in granulocytes, natural killer cells, IgA, Interleukin 6, and an
increase in cell cytotoxicity. Brief naturalistic stressors elicit a shift from Th1(cellular) to Th2(humoral) immunity
, while decreased T-
cell proliferation, and natural killer cell cytotoxicity. Stressful event sequences did not elicit a consistent immune response; however,
some observations such as decreased T-Cell proliferation and cytotoxicity, increase or decrease in natural killer cell cytotoxicity, and
an increase in mitogen PHA. Chronic stress elicited a shift toward Th2 immunity, as well as decreased interleukin 2, T cell
proliferation, and antibody response to the influenza vaccine. Distant stressors did not consistently elicit a change in immune

Some studies have observed increased risk of upper respiratory tract infection during chronic life stress. In patients with HIV,
increased life stress and cortisol was associated with poorer progression of HIV

Chronic disease
A link has been suggested between chronic stress and cardiovascular disease.[42] Stress appears to play a role in hypertension, and
may further predispose people to other conditions associated with hypertension.[46] Stress may also precipitate a more serious, or
relapse into abuse of alcohol.[3] Stress may also contribute to aging and chronic diseases in aging, such as depression and metabolic

The immune system also plays a role in stress and the early stages of wound healing. It is responsible for preparing the tissue for
repair and promoting recruitment of certain cells to the wound area.[44] Consistent with the fact that stress alters the production of
cytokines, Graham et al. found that chronic stress associated with care giving for a person with Alzheimer's disease leads to delayed
wound healing. Results indicated that biopsy wounds healed 25% more slowly in the chronically stressed group, or those caring for a
person with Alzheimer's disease.[47]
Chronic stress has also been shown to impair developmental growth in children by lowering the pituitary gland's production of
growth hormone, as in children associated with a home environment involving serious marital discord, alcoholism, or child abuse.[48]

More generally, prenatal life, infancy, childhood, and adolescence are critical periods in which the vulnerability to stressors is
particularly high.[49][50]

Chronic stress is seen to affect the parts of the brain where memories are processed through and stored. When people feel stressed,
stress hormones get over-secreted, which affects the brain. This secretion is made up of glucocorticoids, including cortisol, which are
steroid hormones that the adrenal gland releases, although this can increase storage of flashbulb memories it decreases long-term
potentiation (LTP).[51][52] The hippocampus is important in the brain for storing certain kinds of memories and damage to the
hippocampus can cause trouble in storing new memories but old memories, memories stored before the damage, are not lost.[53] Also
high cortisol levels can be tied to the deterioration of the hippocampus and decline of memory that many older adults start to
experience with age.[52]

Chronic stress also shifts learning, forming a preference for habit based learning, and decreased task flexibility and spatial working
memory, probably through alterations of thedopaminergic systems.[36] Stress may also increase reward associated with food, leading
to weight gain and further changes in eating habits.[54] Stress may contribute to various psychosomatic disorders, such as
fibromyalgia,[55] chronic fatigue syndrome,[56] depression,[57] and functional somatic syndromes.[58]

Psychological concepts

Selye published in year 1975 a model dividing stress into eustress and distress.[59] Where stress enhances function (physical or
mental, such as through strength training or challenging work), it may be considered eustress. Persistent stress that is not resolved
through coping or adaptation, deemed distress, may lead toanxiety or withdrawal (depression) behavior.

The difference between experiences that result in eustress and those that result in distress is determined by the disparity between an
experience (real or imagined) and personal expectations, and resources to cope with the stress. Alarming experiences, either real or
imagined, can trigger a stress response.[60]

Responses to stress include adaptation,psychological coping such as stress management, anxiety, and depression. Over the long term,
distress can lead to diminished health and/or increased propensity to illness; to avoid this, stress must be managed.

Stress management encompasses techniques intended to equip a person with effective coping mechanisms for dealing with
psychological stress, with stress defined as a person's physiological response to an internal or external stimulus that triggers the fight-
or-flight response. Stress management is effective when a person uses strategies to cope with or alter stressful situations.

There are several ways of coping with stress,[61] such as controlling the source of stress or learning to set limits and to say "no" to
some of the demands that bosses or family members may make.

A person's capacity to tolerate the source of stress may be increased by thinking about another topic such as a hobby, listening to
music, or spending time in a wilderness.
A way to control stress is first dealing with what is causing the stress if it is something the individual has control over. Other methods
to control stress and reduce it can be: to not procrastinate and leave tasks for last minute, do things you like, exercise, do breathing
routines, go out with friends, and take a break. Having support from a loved one also helps a lot in reducing stress.

One study showed that the power of having support from a loved one, or just having social support, lowered stress in individual
subjects. Painful shocks were applied to married women's ankles. In some trials women were able to hold their husband's hand, in
other trials they held a stranger's hand, and then held no one's hand. When the women were holding their husband's hand, the
response was reduced in many brain areas. When holding the stranger's hand the response was reduced a little, but not as much as
when they were holding their husband's hand. Social support helps reduce stress and even more so if the support is from a loved

Cognitive appraisal
Lazarus[62] argued that, in order for a psychosocial situation to be stressful, it must be appraised as such. He argued that cognitive
processes of appraisal are central in determining whether a situation is potentially threatening, constitutes a harm/loss or a challenge,
or is benign.

Both personal and environmental factors influence this primary appraisal, which then triggers the selection of coping processes.
Problem-focused coping is directed at managing the problem, whereas emotion-focused coping processes are directed at managing
the negative emotions. Secondary appraisal refers to the evaluation of the resources available to cope with the problem, and may alter
the primary appraisal.

In other words, primary appraisal includes the perception of how stressful the problem is and the secondary appraisal of estimating
whether one has more than or less than adequate resources to deal with the problem that affects the overall appraisal of stressfulness.
Further, coping is flexible in that, in general, the individual examines the effectiveness of the coping on the situation; if it is not
having the desired effect, s/he will, in general, trydifferent strategies.[63]


A renewed interest in salivary alpha amylase as a marker for stress has surfaced. Yamaguchi M, Yoshida H (2005) have analyzed a
newly introduced hand-held device called the Cocorometer developed by Nipro Corporation of Japan. They state that this can be
reliably used to analyze the amylase levels and is definitely a cheaper alternative as compared to the more expensive ELISA kits. The
working consists of a meter and a saliva collecting chip, which can be inserted into the meter to give the readings. The levels of
amylase obtained have been calibrated according to standard population, and can be categorized into four levels of severity

Measuring stress levels independent of differences in people's personalities has been inherently difficult: Some people are able to
process many stressors simultaneously, while others can barely address a few. Such tests as the Trier Social Stress Test attempted to
isolate the effects of personalities on ability to handle stress in a laboratory environment. Other psychologists, however, proposed
measuring stress indirectly, through self-tests.

Because the amount of stressors in a person's life often (although not always) correlates with the amount of stress that person
experiences, researchers combine the results of stress and burnout self-tests. Stress tests help determine the number of stressors in a
person's life, while burnout tests determine the degree to which the person is close to the state of burnout. Combining both helps
researchers gauge how likely additional stressors will make him or her experience mental exhaustion.

Health risk factors

Both negative and positive stressors can lead to stress. The intensity and duration of stress changes depending on the circumstances
and emotional condition of the person suffering from it (Arnold. E and Boggs. K. 2007). Some common categories and examples of
stressors include:

Sensory input such aspain, bright light, noise, temperatures, or environmental issues such as a lack of control over
environmental circumstances, such asfood, air and/or water quality, housing, health, freedom, or mobility.
Social issues can also cause stress, such as struggles withconspecific or difficult individuals and social defeat, or
relationship conflict, deception, or break ups, and major events such asbirth and deaths, marriage, and divorce.
Life experiences such aspoverty, unemployment, clinical depression, obsessive compulsive disorder, heavy
drinking,[66] or insufficient sleep can also cause stress. Students and workers may face performance pressure stress
from exams and project deadlines.
Adverse experiences duringdevelopment (e.g. prenatal exposure to maternal stress,[67][68] poor attachment
histories,[69] sexual abuse)[70] are thought to contribute to deficits in the maturity of an individual's stress response
systems. One evaluation of the different stresses in people's lives is theHolmes and Rahe stress scale.

General adaptation syndrome

Physiologists define stress as how the body reacts to a stressor, real
or imagined, a stimulus that causes stress. Acute stressors affect an
organism in the short term; chronic stressors over the longer term.
The general adaptation syndrome (GAS), developed by Hans Selye,
is a profile of how organisms respond to stress; GAS is characterized
by three phases: a nonspecific mobilization phase, which promotes
sympathetic nervous system activity; a resistance phase, during
which the organism makes efforts to cope with the threat; and an
exhaustion phase, which occurs if the organism fails to overcome the
threat and depletes its physiological resources.[71]

A diagram of the General Adaptation Syndrome

Stage 1
Alarm is the first stage, which is divided into two phases: the shock
phase and the antishock phase.[72]

Shock phase: During this phase, the body can endure changes such ashypovolemia, hypoosmolarity, hyponatremia,
hypochloremia, hypoglycemia—the stressor effect. This phase resemblesAddison's disease. The organism's
resistance to the stressor drops temporarily below the normal range and some level of shock (e.g. circulatory shock)
may be experienced.
Antishock phase: When the threat or stressor is identified or realized, the body starts to respond and is in a state of
alarm. During this stage, thelocus coeruleus/sympathetic nervous system is activated and catecholamines such as
adrenaline are being produced, hence thefight-or-flight response. The result is: increasedmuscular tonus, increased
blood pressure due to peripheral vasoconstrictionand tachycardia, and increased glucose in blood. There is also
some activation of theHPA axis, producing glucocorticoids (cortisol, aka the S-hormone or stress-hormone).

Stage 2
Resistance is the second stage and increased secretion of glucocorticoids play a major role, intensifying the systemic response—they
have lipolytic, catabolic and antianabolic effects: increased glucose, fat and amino acid/protein concentration in blood. Moreover,
they cause lymphocytopenia, eosinopenia, neutrophilia and polycythemia. In high doses, cortisol begins to act as a mineralocorticoid
(aldosterone) and brings the body to a state similar to hyperaldosteronism. If the stressor persists, it becomes necessary to attempt
some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the
body cannot keep this up indefinitely, so its resources are gradually depleted.

Stage 3
The third stage could be eitherexhaustion or recovery:
Recovery stage follows when the system's compensation mechanisms have successfully overcome the stressor
effect (or have completely eliminated the factor which caused the stress). The high glucose, fat and amino acid
levels in blood prove useful for anabolic reactions, restoration of homeostasis and regeneration of cells.
Exhaustion is the alternative third stage in the GAS model. At this point, all of the body's resources are eventually
depleted and the body is unable to maintain normal function. The initialautonomic nervous systemsymptoms may
reappear (sweating, raised heart rate, etc.). If stage three is extended, long-term damage may result (prolonged
vasoconstriction results inischemia which in turn leads to cell necrosis), as the body's immune system becomes
exhausted, and bodily functions become impaired, resulting indecompensation.
The result can manifest itself in obvious illnesses, such as general trouble with the digestive system (e.g. occult bleeding, melena,
constipation/obstipation), diabetes, or even cardiovascular problems (angina pectoris), along with clinical depression and other
mental illnesses.

History in research
The current usage of the word stress arose out of Selye's 1930s experiments. He started to use the term to refer not just to the agent
but to the state of the organism as it responded and adapted to the environment. His theories of a universal non-specific stress
response attracted great interest and contention in academic physiology and he undertook extensive research programs and
publication efforts.[73]

While the work attracted continued support from advocates of psychosomatic medicine, many in experimental physiology concluded
that his concepts were too vague and unmeasurable. During the 1950s, Selye turned away from the laboratory to promote his concept
through popular books and lecture tours. He wrote for both non-academic physicians and, in an international bestseller entitled Stress
of Life, for the general public.

A broad biopsychosocial concept of stress and adaptation offered the promise of helping everyone achieve health and happiness by
successfully responding to changing global challenges and the problems of modern civilization. Selye coined the term "eustress" for
positive stress, by contrast todistress. He argued that all people have a natural urge and need to work for their own benefit, a message
that found favor with industrialists and governments.[73] He also coined the term stressor to refer to the causative event or stimulus,
as opposed to the resulting state of stress.

Selye was in contact with the tobacco industry from 1958 and they were undeclared allies in litigation and the promotion of the
concept of stress, clouding the link between smoking and cancer, and portraying smoking as a "diversion", or in Selye's concept a
"deviation", from environmental stress.[74]

From the late 1960s, academic psychologists started to adopt Selye's concept; they sought to quantify "life stress" by scoring
"significant life events", and a large amount of research was undertaken to examine links between stress and disease of all kinds. By
the late 1970s, stress had become the medical area of greatest concern to the general population, and more basic research was called
for to better address the issue. There was also renewed laboratory research into the neuroendocrine, molecular, and immunological
bases of stress, conceived as a useful heuristic not necessarily tied to Selye's original hypotheses. The US military became a key
center of stress research, attempting to understand and reduce combatneurosis and psychiatric casualties.[73]

The psychiatric diagnosis post-traumatic stress disorder (PTSD) was coined in the mid-1970s, in part through the efforts of anti-
Vietnam War activists and the Vietnam Veterans Against the War, and Chaim F. Shatan. The condition was added to the Diagnostic
and Statistical Manual of Mental Disorders as posttraumatic stress disorder in 1980.[75] PTSD was considered a severe and ongoing
emotional reaction to an extreme psychological trauma, and as such often associated with soldiers, police officers, and other
emergency personnel. The stressor may involve threat to life (or viewing the actual death of someone else), serious physical injury, or
threat to physical or psychological integrity. In some cases, it can also be from profound psychological and emotional trauma, apart
from any actual physical harm or threat. Often, however
, the two are combined.

By the 1990s, "stress" had become an integral part of modern scientific understanding in all areas of physiology and human
functioning, and one of the great metaphors of Western life. Focus grew on stress in certain settings, such as workplace stress, and
stress management techniques were developed. The term also became a euphemism, a way of referring to problems and eliciting
sympathy without being explicitly confessional, just "stressed out". It came to cover a huge range of phenomena from mild irritation
to the kind of severe problems that might result in a real breakdown of health. In popular usage, almost any event or situation
between these extremes could be described as stressful.

The American Psychological Association's 2015 Stress In America Study[76] found that nationwide stress is on the rise and that the
three leading sources of stress were "money", "family responsibility", and "work".

See also
Autonomic nervous system
Defense physiology
HPA axis
Stress (psychology)
Trier social stress test
Stress in early childhood

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External links
The American Institute of Stress
"Research on Work-Related Stress", European Agency for Safety and Health at W
ork (EU-OSHA)
Coping With Stress
Stages of GAS & Evolving the Definition

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