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Definition and Diagnosis

Stress is defined as a situation where the demands placed upon the individual are greater than their perceived resources. Stress can be understood in terms of the following three ways:

1.Stress as a stimulus: Environmental events such as war, earthquake, famine and accidents can cause stress even when the coping abilities of the individual are good.

2.Stress as a response: A stress prone person experiences high levels of stress even in situations considered normal life events by most individuals. Stress in this context can be viewed as a mental reaction that results from the judgements we make all the time about people, situations and things.

3.Stress as an interaction between the individual and the environment: In most situations it is the interaction between the individual and their environment that brings on stress e.g. relationship problems.

Stress is a very popular term and almost everyone understands when we use this term. However, when discussing mental illness, it often causes confusion, as it fails to convey the precise nature of the problem. Almost all psychological problems, be it anxiety, depression, psychosis etc., have elements of stress and the use of this term doesn't help distinguish one from another.

To simplify the matter, one can say that stress is an overarching term and it manifests differently in different individuals depending upon their personalities and mental state. Stress can result in alcoholism, drug addiction or violent episodes in one person and depression, relationship problems, panic or phobia in another. General stress management strategies can help all of those individuals

Most of our daily actions and interactions produce stress. Very much like our clothes that pick up dust and grease during the course of the day. We put our clothes in a washing machine for cleaning and the cycle takes about an hour or two for cleaning them. What about our minds? What do we do to undo the stress ? 

The common answer to this question is to have a drink or sit in front of television. Unfortunately there is very little scientific evidence that these two activities will undo stress.

Stress management should be seen as a preventative activity rather than a treatment of the problem when it has already resulted in illness. It should be practiced daily similar to cleaning our teeth every morning. We don't just clean our teeth when they get dirty. In the same way it is better to prevent stress or manage it when it hasn't reached breaking point.

Most people who experience stress don't have a psychiatric illness, but it is a condition which requires a proper understanding and careful management as it could affect almost every aspect of ones life. The following could be used as a rough guide to assess your stress levels.

• Knowing how you feel first thing in the morning: you are connected to the inner most reaches of your mind during sleep and how you feel soon after waking is a good parameter of your inner mental life. Clients with high levels of stress report feeling unwell and tired first thing on most mornings and the feeling continues. They feel unrefreshed after a night's sleep.

How you feel at work: Occasionally wishing you didn't have to come to work and wanting to go home can be normal, but if this happens often it can signal stress. Feeling the need for frequent cups of coffee, tea or smoking to keep you going and being desperate for a holiday only a few months after the last can be a sign of stress.

• How you feel at the end of the day: Stress can manifest as tiredness, exhaustion and having headaches at the end of the day. If, after returning home and relaxing for a while you still want to relax and do nothing, this could be a sign of stress. Not being able to have a life after five could be a sign of stress.

• Frequent unpleasant dreams and nightmares: It is normal to experience both pleasant as well as unpleasant dreams, but if the proportion of unpleasant dreams is higher than that of pleasant ones, some action is required.

• Anxiety and panic: Panic typically manifests as intense fear or discomfort that develop abruptly and reach a peak within ten minutes. It is characterised by palpitations, sweating, trembling, sensation of shortness of breath, choking, chest pain, dizziness, lightheadedness, fear of losing control and dying etc

• How you feel at the weekend: Stress can manifest differently in different individuals. For some it manifests as not being comfortable with their own company; they are always seeking another activity in order to avoid being on their own as they can not tolerate solitude, whereas for others it can manifest as not wanting to be with people and they withdraw into their own shell. This can be explained as a difference in personality. Extroverts find that their batteries are charged when they are with people and doing some activity, hence when stressed they always seek company or an activity which serves as a distraction from their own inner problems. For others, mainly the introverts, stress manifests as an accentuation of their trait of withdrawing into their own shell. Social contact can lead to more stress for them and as a result, they avoid interacting with others.

• Relationship and sexual difficulties: For some individuals, the first sign of stress is problems in relationships that can occur for a number of different reasons. Denial of the stress that one feels within oneself can then result in its projection on to a relationship resulting in being over critical, intolerance of others, irritable, angry and having sexual problems. It is interesting to note that stress affects men and women differently - men report erectile problems and ejaculatory difficulties whereas for women the stress is more likely to manifest in the form of loss of desire and interest in sex. We do not know why men do not suffer from desire problems as much as women.

• Overeating, increase in smoking and drinking: Eating brings a sense of comfort and relief from anxiety which is used by some individuals to manage their anxieties. It doesn't neutralise the stress but makes it disappear for a short while. Similarly drinking alcohol creates a temporary wall between you and your stress and the feelings of stress return as soon as the effect wears off.

• Psychological disorders: Difficulty making decisions, forgetfulness, inability to concentrate, anger, crying spells, feeling powerless, irritability, impulsive acts, frequent mood swings, loneliness, negative thinking and hopelessness are all symptoms of stress. Suffering from all these could indicate high levels of stress and it may or may not be severe enough to warrant a psychiatric diagnosis. It is only when these cause significant distress and incapacitation in everyday life and the individual can not shake them off that a psychiatric diagnosis is made.

• Suffering from a psychosomatic illness: Stress prone individuals report higher rates of bodily symptoms such as aches and pains, indigestion, allergies, headaches, backaches and they interpret these symptoms as indicative of a physical illness. Apart from these symptoms that resolve within a few hours, some individuals go on to develop medical disorders wherein stress plays an important part. Individuals suffering from illnesses such as migraine, hypertension, diabetes, asthma, IBS, menopausal hot flushes, premenstrual tension can have stress symptoms which could either be the cause, consequence or a reflection of the disease process. Stress management strategies can improve the prognosis of these disorders.