Category: Happy x Mindful

Post-traumatic stress disorder, or PTSD, is often thought of in terms of its effect on military veterans who have witnessed or participated in the horrors of war. The reality of this life-altering disorder is that it can occur after any type of trauma, from being a victim of violence to enduring a catastrophic natural disaster to being bitten by a dog as a child.
Considering the ubiquitous nature of trauma and the 24.4 million Americans who suffer from this disorder, it’s important to address the stigma surrounding PTSD and the people who experience it day-to-day. When it comes to PTSD, knowledge is empowering for everyone.

What is post-traumatic stress disorder?

The National Institute of Mental Health (NIMH) states that post-traumatic stress disorder “can develop after exposure to a potentially traumatic event that is beyond a typical stressor. Events that may lead to PTSD include, but are not limited to, violent personal assaults, natural or human-caused disasters, accidents, combat, and other forms of violence.” They highlight the fact that while most people will, at some point in their lives, be exposed to an event which fits the criteria of trauma, only a small percentage of people will go on to receive a diagnosis of PTSD.

Types of Post-Traumatic Stress Disorder

Uncomplicated PTSD

This type of PTSD occurs when an individual has experienced loss of life or widespread destruction for an extended amount of time. People suffering from uncomplicated PTSD seek out ways to avoid the traumatic event through denial and this can lead to detachment from people and real world situations.

Complex PTSD

Complex PTSD is a result of repeated, inescapable tragedies that are endured over months and years. As a result of natural coping mechanisms in the brain, sufferers of complex PTSD often have the false belief that if the trauma is never spoken about they will be okay. This belief is caused by the disconnect the survivor has placed between themselves and their trauma.

Acute Stress Disorder

This disorder is defined as the formation of severe anxiety, dissociation, and emotional detachment. Those who suffer from acute stress disorder are likely to avoid anything or anyone who reminds them of the original trauma and may become easily irritated or startled and experience difficulty sleeping.

Comorbid PTSD

Current data shows that the majority of people suffering from PTSD have also been diagnosed with at least one other psychiatric disorder (such as anxiety, depression, or substance abuse). Scientists believe that the higher risk for drug and alcohol abuse in these individuals can be largely explained by the increased likelihood of self-medication.

How is post-traumatic stress disorder diagnosed?

In order for an adult to be diagnosed with PTSD they must meet the following set of criteria as presented in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders):

Exposure

They must have been exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence (such as direct exposure, actually witnessing the trauma, learning a loved one was exposed to trauma, or indirect exposure to trauma through professional duties).

Re-Experiencing

They must have at least one re-experiencing symptom, such as unwanted and upsetting memories, nightmares, flashbacks, emotional distress, and physical reactivity to traumatic reminders.

Avoidance

They must have at least one avoidance symptom, such as avoidance of trauma-related thoughts, feelings, or trauma-related reminders.

Arousal and Reactivity

They must have at least two arousal and reactivity symptoms, such as irritability or aggression, risky or destructive behavior, increased alertness to their surroundings, heightened startle reaction, difficulty concentrating, and difficulty sleeping.

Cognition and Mood

At least two cognition and mood symptoms, such as trouble remembering important features of the event, overly negative thoughts about themselves and the world, exaggerated blame of themselves or others for causing the trauma, negative mood, decreased interest in activities that once brought joy, feelings of isolation, and difficulty feeling happiness.

Post-Traumatic Stress Disorder and Young Children

Young children can be susceptible to PTSD if they have experienced trauma such as death of a loved one, abuse, neglect, war, disaster, and even dog bites (although the symptoms may be slightly different than those of an adult).
Young children can have difficulties remembering the correct sequence of events that occurred at the time of the trauma. They might also practice omen formation, which is “a belief that there were warning signs that predicted the trauma.” Other symptoms of childhood PTSD can include a fear or mistrust of strangers and family members, traumatic play (where components of the trauma are acted out), and regressive behavior such as thumb sucking and bedwetting.

Post-Traumatic Stress Disorder and Teens

Teens experiencing PTSD have symptoms that may include separation anxiety, difficulty with impulse control (which can manifest as problems with drugs and alcohol), and aggressive behavior (such as instigating fights with friends and family members).

Post-Traumatic Stress Disorder and Women

Although women have a slightly lower chance of experiencing trauma when compared to men (around 50 percent of women will endure trauma during their lives), women are over two times as likely to develop PTSD. The sad truth is that women have a much higher chance of experiencing rape, sexual abuse, childhood sexual abuse, or physical and mental abuse at the hands of their partners.
PTSD symptoms for women can include an overall sense of nervousness, becoming easily frightened, developing anxiety and depression, and avoidant behavior. Women are also more likely to shoulder the blame for incidents of trauma, placing responsibility on themselves even if they were the victim.

Why does post-traumatic stress disorder happen?

Considering the atrocities of war that both soldiers and civilians are exposed to, it’s no surprise that PTSD is most often associated with the military. It’s estimated that, depending on the war in question, anywhere from 11 to 30 percent of veterans have experienced PTSD during their lifetime. Unfortunately, the reality of PTSD is that anyone who experiences trauma is at risk of developing the disorder.
Jennifer* is a 30-something teacher, visual artist, wife, and mother who also happens to suffer from PTSD due to the sudden death of her father. She shares:

I have been struggling with PTSD for 17 years. For a long time, I never knew what it was or what was happening to me. When I was 16 I watched my father died of a massive heart attack in front of me. He was lying on the couch downstairs. I was upstairs on the computer and I remember my mom yelling his name over and over. I went downstairs to find him holding his chest and staring at me. It sounded like he was trying to say something but I was just trying to reassure him that the ambulance was on its way and that he was going to be okay. He wasn’t okay. By the time we got to the hospital he had already passed away. This was 17 years ago last November.

It’s important to point out that PTSD-related reactions to situations and people don’t have to directly mirror the circumstances of the original trauma. Jennifer explains that after her father’s death she would panic whenever she had any sense something bad might have happened to a loved one, even it was unrelated to her father’s heart attack:

If anything would happen that related to heath, I would panic. It would take me back to that image of my father in the couch. I now know that people die. They can die at any time and they can die right in front of me. If my mom wouldn’t answer the phone I would automatically assume she was lying on the floor dead or hurt. If I had a pain in my chest, it was a heart attack. That thought, that image of him. Still there. I always just lived with this feeling. These thoughts and extreme fear were a part of my life now. I just assumed I was broken. Actually, I just assumed that everyone was going to die in front of me.

Post-Traumatic Stress Disorder and Motherhood

The effects of PTSD on everyday life can’t be overemphasized. They can be overwhelming, panic-inducing, and life-altering. For mothers, PTSD can be exceptionally difficult to deal with, let alone overcome when they are so busy taking care of their children. When Jennifer had her children, she found herself experiencing panic when she thought of her father’s death and the inevitability of death in general:

After having them (and less sleep) I really found myself having a hard time not thinking about my dad, and how much I loved him and how now I have these little boys that I love so much—more than anything in the world—and what if I lost them like I lost him?

Jennifer says if her kids’ names are called and they don’t answer, it takes her back to the day she was upstairs and her mom was calling her dad’s name:

As a mother, I try to shield my kids from how I feel when I am panicking, but it is impossible. They see me react. They know I am afraid. I feel terrible about it. I worry constantly that I am going to give them fears that are irrational.

The compound nature of anxiety, wherein one small worry quickly escalates into an end-of-the-world scenario in the victim’s mind, can be greatly exacerbated by motherhood. Suddenly, good mental health hygiene practices (such as plenty of sleep, time for self-care, and plenty of partner support) that may have been common practice prior to having children can inadvertently be pushed aside by the demands of motherhood. Jennifer is very familiar with this conundrum, saying, “I also found that with the kids, I am finding it hard to make it to my CBT appointments. I am so busy with work and being a mom that I am not taking care of my mental health nearly as much as I should be.” It’s clear that accessible, affordable treatment is needed for mothers (and others who suffer from PTSD), so what does PTSD treatment look like?

Treatment of Post-Traumatic Stress Disorder: A Multi-Pronged Approach

PTSD is commonly treated with psychotherapy and medication. Different approaches and treatment options include:

Cognitive Behavioral Therapy (CBT)

CBT addresses PTSD patients’ thought patterns and focuses on the mental constructs (like phobias) that are adversely impacting their day-to-day life. Specifically, a therapist will help a patient recognize self-doubt, social anxiety, and fear that the traumatic event will reoccur. CBT can combine talk therapy, journaling, and education about anxiety-management techniques.

Eye Movement Desensitization and Reprocessing (EMDR)

EDMR is a type of therapy that involves processing trauma while following guided movements. Over the course of treatment, the practice eventually helps change your reaction to the traumatic thoughts.

Exposure Therapy

Exposure therapy involves addressing traumatic thoughts directly and can involve discussions with a therapist or physically doing activities related to the original trauma. Exposure therapy is often combined with cognitive behavioral therapy.

Medication

Antidepressants that fall under the SSRI (selective serotonin reuptake inhibitors) heading are the drugs most commonly used to combat the symptoms of PTSD. These include medications such as Celexa, Lexapro, Prozac, Paxil, and Zoloft. Antidepressants are often used in conjunction with psychotherapy.

Alternative Treatments for Post-Traumatic Stress Disorder

While psychotherapy and medication have been proven to be the most effective treatments for PTSD, many people use alternative or complementary therapies as further means to support themselves through their daily lives. Animal therapy, acupuncture, meditation, and guided relaxation are all examples of commonly used alternative or complementary therapies. Although research in these area is limited or inconclusive, the U.S. Department of Veterans Affairs supports the study of these methods and their use when combined with psychotherapy and/or medication.

How are children treated for post-traumatic stress disorder?

Treatment of children who have PTSD utilizes cognitive behavioral therapy and eye movement desensitization in addition to play therapy. Play therapy is used for children ages 3 to 8 and involves the use of natural expression (play) as a therapeutic means for coping with emotional stress and trauma.

How to Support Someone Who’s Struggling With PTSD

Relationships with others are especially crucial for individuals with PTSD and support from friends and family has proven to have a lasting positive effect on individuals coping with PTSD. Why are relationships so important? They can help alleviate guilt that is attached to the incident, they lower the chances of depression and overwhelming anxiety, and they can shift the focus of the individual away from the traumatic event and themselves and onto maintaining healthy relationships with other people.
Therapy is also important, both for the person with PTSD and for those doing the supporting, and can take the form of marriage counseling, counseling from a place of religious worship, family education classes, anger management, or group therapy.
In addition to in-person sources of support, there are many online organizations that provide help in the form of internet forums, education and awareness, volunteer work, and 1-800 hotlines that provide counseling and support over the phone.
Sidran: Traumatic Stress Education & Advocacy provides resources for survivors and their loved ones as well as information for mental health workers and advocates.
NAMI (National Alliance on Mental Illness) offers a wealth of information on mental health and illnesses, including PTSD. It also offers information and support for mothers suffering from PTSD.
The U.S. Department of Veterans Affairs’ website provides excellent information on the diagnosis and treatment of PTSD as well as resources for loved ones. It also hosts information pertaining to PTSD caused by non-military events.
*Some last names have been omitted from this article to respect contributors’ privacy.

Take a deep breath.
How many times has someone said this to you when you were feeling stressed? When you’re stuck in a traffic jam, prepping for a high-stakes presentation, or in the midst of a passionate argument with your SO, there is a lot to be said for simply…taking a breath.
Why is breathing so effective at calming us down or at least helping us come back to our bodies? And why are breathing exercises at the root of almost any meditation or relaxation practice?
“The widely advertised reason why we pay attention to breath during meditation is because it’s constantly changing,” explains Mark Miller, PsyD, master of public health, clinical psychologist, and mindfulness teacher at the University of Southern California. “We have a consistent target, so we can pay attention to something that’s changing and learn to tolerate that.”
The less commonly advertised reason, however, is much more profound.
“When we pay attention during meditation, we notice that we don’t have control over the breath—and in fact over anything!” explains Miller, “…what we think, what emotions we are feeling, what stories we are playing out in our minds…”
So we sit, breathe, and tolerate letting the breath do what it does. This, in turn, is excellent practice for tolerating all the other things in our lives that are out of our control.

Breathing exercises help us return to the now.

“The breath is happening in the here and now,” explains Jennifer Brilliant, a certified yoga teacher, therapist, and medical exercise specialist who has been teaching yoga for more than 30 years. “We have bummer feelings about the past and anxious feelings about the future, but of course none of those are happening right now.”
It’s hard to tell our minds to stop thinking, but if you engage the breath, you can get some relief.
“Even taking a couple of breaths can ground you in the present moment,” says Brilliant.
When we get stressed, most of us have a fight or flight response, which shortens our breath and prepares us for battle. This is useful in the moment, but it starts to wear on us if we stay in this state over time. According to a resource hosted by Harvard Health Publishing, stress leads to everything from lowered immune responses to anxiety and depression to high blood pressure, which is a risk factor strongly associated with heart disease.
Instead of taking a pill, we can tap into our built-in calming device: the breath.

The Nervous System in a Nutshell

The sympathetic nervous system is for emergencies, Miller explains. The parasympathetic nervous system helps us to relax and move toward equilibrium.
“When we have an adrenaline rush from a worried thought, our breathing increases and our body is mobilizing to take action related to the fantasy,” says Miller. “We are at the whim of our breath. The sympathetic nervous system gets engaged all the time—from tiny squirts of adrenaline all the way to a panic attack.”
These worried thoughts can come from anywhere. Will I get home on time? Will I get the job? Is my partner mad at me? When these thoughts occur, the parasympathetic nervous system can help us cope.
How do we the engage the parasympathetic nervous system? Miller suggests we should become “fascinated with the symptoms of our anxiety in our distress.” In other words, using a meditation or mindfulness practice, we can take an interest in the breath that will help us experience the sensations in our bodies without running away.
“During a panic attack, you can move toward the sensations in the body, not toward the scenario or thoughts,” he says. “If you can become familiar with sensation”—shortness of breath, heart racing—“the more it happens, the less afraid you’ll be. It becomes an old friend who [you] don’t want to visit often, but you can say, ‘I know this. There it is!’ Instead of resisting you can allow it to play out.”
Sitting with the breath, as it is, is a way to practice sitting through all sorts of discomfort in our lives.

A Note on Breathing Exercises

More prescriptive breath practices like pranayama should always be attempted with a teacher first. What we are sharing here are simple exercises you can do almost any place or any time to give yourself a little relief.

Simply pay attention.

How often do you pay attention to your breath—actually pay attention? Obviously, you’re already breathing, but can you put your awareness on your breath without changing anything?
“With total newbies, I usually work on breath awareness,” Brilliant says. “Where do you feel your breath in your body? Do you feel it coming into your nostrils? If you breathe in, it feels cool. When you breathe out, it feels warmer.”
Another way of tapping into the breath and your body is to notice what’s happening in the space around you—and within you. Listen to sounds in and out of the room you’re in, Brilliant suggests. Can you hear airplanes, cars, birds, dogs barking? Is your stomach growling? Are your ears ringing? Can you feel your heartbeat? The breath can help you tune in to the present moment both inside and outside of your own physical being.
This can also be extremely useful if you’re feeling anxious.
“In the midst of a panic attack, we tend to judge the panic,” explains Carly Goldstein, PhD, assistant professor at Alpert Medical School of Brown University and research scientist at the Miriam Hospital. “If you can focus on your breath, accept that it’s faster and not what you want, you can eventually calm down. I think of breathing as a way to hijack the nervous system.”
Miller notes that trying to change the breath or creating a scenario around the panic (“My heart is beating so fast that I must be having a heart attack!”) only increases the panic.
“When we control panicked breathing by trying to slow it down, it causes more intense panicked breathing,” he explains. “If you are successful in slowing it down, you end up having chest pain. When we fight that uncomfortable breathing, our throat constricts, our shoulders go up, [and] we cause more panic.”
The answer is to leave the breath open and allow yourself time and space to experience it as it is. This is an exercise in familiarizing yourself with your breath.

Try it

Lie down on flat on your back. Put your hands on your chest and breathe a few times without changing anything. Can you feel your chest move as you breathe? Move your hands down to your ribs. Do your ribs move? Your side ribs? Your belly? Don’t force it or ask it to change. You’re just observing the breath here.

Tip

When you’re lying on the floor, your body should have sufficient space to breathe. In other words, there should be air between your upper arm and torso (in your armpit), and your legs shouldn’t be touching each other.

Scan your body with breathing.

During her internship and residency, Goldstein worked in a hospital setting, often with patients who were critically ill. As anyone who has been in the hospital knows, it can be incredibly stressful. Doctors have little time, and patients sometimes have difficulty advocating for themselves.
“When the team was coming by for rounds, I’d do breathing with the patient beforehand to clear her mind and get her thoughts in order,” Goldstein says. “Then when the medical team arrived, the patient could present her interests and advocate for herself.”
The breathing exercise Goldstein would most commonly use in this setting was a body scan with breathing. This exercise can be seen as the follow-up to just paying attention.
Here you’re asked to draw your mind to one body part at a time while you breathe. Part of its benefit is the way it can focus the mind. Instead of allowing yourself to spin out of control, your task is to place your attention on a specific part of your body—such as your toes, your heels, or your ankles—and to feel the breath move through. (Obviously, you don’t have breath in your toes! But the idea is that you can relax each inch of your body to calm down.)

Try it

Depending on how much time you have, this can be done with bigger body parts (e.g., legs, belly, chest) or on an almost infinitesimal level (first knuckle of the thumb, second knuckle, and so on).
Begin by breathing normally. Scan from the top down, sending healing, warm energy to each part of the body. Take stock of what that part of the body feels like. (Is your head tight? Tingling? Pounding? Is there no sensation at all?) Then inhale and exhale through five breath cycles for each body part.
“You can use imagery,” explains Goldstein, “a light, a feeling of fuzziness, running through or on top of [your] body, regulating the breath to be even and slow. Picture warmth, comfort, relaxation.”

TIP

With each exhale, relax a little more. If you ever feel your breath getting forced, just go back to breathing totally normally.

To calm down (or even lose weight) elongate your exhale.

Breathing exercises can serve as a pause button, slowing down the chaos of our everyday lives. In her clinical practice, Goldstein works with weight-loss patients and finds that breathing techniques can help when someone is overwhelmed by a craving. These exercises short-circuit the “need-to-have-it, limited-resource” mentality, she explains.
When we can breathe deeply again (instead of, say, grabbing the bag of chips), we can reconnect to our values and what’s most important to us (in Goldstein’s patients’ cases, to lose weight). And then it will be easier to make good decisions.
Of course, this doesn’t just apply to weight loss! Deep breathing slows the chaos for all of us in moments of panic, and extending the exhale in particular is calming because “the heart rate is naturally slower on the exhalation,” Brilliant explains.

Try It

This is good to practice if you wake up in the middle of the night and can’t get back to sleep or if you’re stuck in traffic and need to calm down.
Begin by breathing in for three seconds and out for three seconds. Then you can start extending the exhalation slowly: three in, four out, without strain. Eventually you can work up to breathing in for five seconds and out for 10.

Tip

This should not be forced. If you feel yourself getting anxious or agitated, go back to regular breathing.

Try a three-part breath.

The three parts of this breathing exercise are low belly, ribs, and chest. Starting in the low belly, the breath fills the body one section at a time. In other words, you’re taking in more air than in some of the preceding exercises. This is an excellent technique to help you find some calm.

Try It

Sit in a chair or lie on the floor and place your hands on your low belly. Fill the low belly with air. Without exhaling, move your palms to your middle ribs and fill that area with air. Bring your hands to your upper chest and take a last sip of air. Exhale all the air out. If you’re doing this in bed, imagine you’re falling into the mattress.

Tip

If it’s too much to do the full three parts right away, you can inhale into the low belly and exhale, middle belly and exhale, etcetera, until you build up the stamina to draw in more air.

Get app support.

A teacher is always the best guide to breathing exercises, but there are plenty of apps that can help you along the way. Here are some to try:

• Headspace offers both basic meditation techniques and more advanced specific guided meditations (for self-esteem, productivity, depression, and more).
• Calm is specifically geared to help you…calm down.
• Buddhify offers meditation on the go.
• Pacifica offers guided meditation and relaxation techniques. Pacifica can also connect you to a therapist who specializes in cognitive behavioral therapy.

You’re having a difficult week at work, and you notice that you’re getting stomach cramps and a backache. Or perhaps your partner is out of town for the week, you’ve been taking on a lot of household and parental duties, and you’re constantly feeling dizzy and nauseated.
There doesn’t seem to be a physical cause for your pain (other than stress, that is). But how do we know whether stress is causing those symptoms? And how can stress—a feeling in your mind—result in physical illness?
We often notice when we feel particularly stressed, but many people don’t realize that stress isn’t just a feeling. It’s a physiological response, and it can cause a physical reaction in your body. It can also cause a number of emotional, cognitive, and behavioral changes.
According to the American Institute of Stress (AIS), 33 percent of people in the United States feel that they’re living with “extreme stress.” A whopping 77 percent of people experience physical symptoms caused by stress, and 73 percent of people experience emotional symptoms due to stress. While many people believe stress is all in your head, it affects your entire body and well-being.
Stress can have a negative impact on nearly every part of your body. In fact, the AIS lists 50 symptoms related to stress: “it’s hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected,” their site reads. “This list will undoubtedly grow as the extensive ramifications of stress are increasingly being appreciated.”
Of course, stressors—that is, the causes of stress—are unavoidable. But by paying attention to the signs, symptoms, and effects of stress, you might be able to control your response to stress. By finding healthy coping techniques for stress, you can reduce the negative impact it has on your body and mind and manage your stress-related symptoms.

Why does stress affect the body?

We know what stress feels like, but it’s often difficult to identify how it affects our bodies. After all, how can a feeling in your mind translate to an illness in your body?
The short answer? Hormones.  
Our bodies go into a “flight-or-fight” mode when faced with stress or danger, says Lisa Herbert, MD, a family physician and life coach. Flight-or-fight mode is also known as a sympathetic response. “During this time of fight or flight, we release hormones which help us to deal with the danger,” Herbert says.
She explains how the symptoms of stress develop: “Our body releases adrenaline, which causes an increased heart rate, elevated blood pressure, and boost of energy supplies. We also release cortisol, which causes increased sugar levels, alters immune system responses, and suppresses the digestive system.”
A little stress is normal and healthy. Most of the time your body goes back to normal soon after the stressful trigger has disappeared. But if you’re constantly faced with stress, it can lead to chronic stress, according to Herbert.
One big misconception about stress is that stress and anxiety disorders are the same thing. Indeed, stress and anxiety often feel similar. Like stress, anxiety triggers a flight-or-fight response, causing the release of certain hormones into the body.
Experiencing chronic stress might lead to anxiety, but the two are not the same. Chronic stress occurs when a stressor is around for a prolonged period. If you have an anxiety disorder, you’ll feel anxious even when the stressor is gone.
Chronic stress is also different from post-traumatic stress disorder (PTSD), which is one of the many kinds of anxiety disorders. PTSD occurs after someone has experienced a particularly traumatic event or series of events, such as abuse, an accident, or war. Even when there is no direct threat or stressor, people with PTSD might feel anxious. Their symptoms can be triggered by anything that reminds them of the traumatic event. A loud bang might trigger a war veteran who’s reminded of gunshots, or driving might trigger someone who survived a car crash.
Other forms of anxiety can include generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, phobias, and more.
Much like chronic stress, anxiety can also have a negative physical effect on other parts of the body. For example, anxiety is associated with gastrointestinal issues, respiratory disorders, and heart conditions.

What causes stress?

We often associate stress with negative experience, but both positive and negative experiences can cause stress. Eustress, which is associated with positive changes and euphoria, differs from distress, which is associated with negative changes. Both eustress and distress can have a negative impact on the body if they are experienced for a prolonged period.
For that reason, a number of the main causes of stress in the U.S. might not be negative in themselves. For example, getting married, starting an exciting new job, or moving to your dream home can all be stressful. Feeling excited or having butterflies in your stomach could be a result of eustress.
According to 2014 statistics from the AIS and the American Psychological Association (APA), the biggest causes of stress were job pressure, money, health issues, and relationships. Other major causes of stress included poor nutrition, technology overload, and sleep deprivation.
Newer causes of stress have emerged over the years. For example, 2017 statistics from the APA show that many adults in the U.S. are stressed by technology and the future of the nation.

The Signs and Symptoms of Stress

How does stress feel? Although stress feels different for everyone, there are some common physical symptoms of stress that are nearly universal. “A person can feel like there is electricity going through their body,” says Prudence Hall, MD, who is a physician, author, and practitioner of regenerative/mindful medicine. “The body feels jittery, nervous, and shaky because of the high levels of cortisol.” Those “butterflies” in your stomach are actually cortisol affecting your digestive system.
“Stress can present as many physical symptoms, including sweating, constipation, abdominal pain, palpitations, insomnia, fatigue, and feeling short of breath,” says Jared Heathman, MD, a Houston-based psychiatrist.
Those high levels of cortisol and adrenaline in your body can be bad news if they’re prolonged. And this can lead to a number of physical symptoms, including:

• Aches, pains, and muscle spasms
• A weaker immune system, resulting in frequent colds or flu
• Digestive issues, including diarrhea, constipation, cramps, and a change in appetite
• Tremors
• Dizziness, lightheadedness, and fainting spells
• Chest pain
• Hair loss
• Fatigue

Stress can also have an impact on your cognitive abilities, which can affect your ability to work, study, read, have conversations, or run errands. Some of the cognitive effects of stress include:

• Racing thoughts
• An inability to concentrate or focus
• Memory problems
• An inability to learn new information or skills
• Procrastination
• Constant worrying

Stress might also cause your behavior to change in the following ways:

• Using or abusing substances like alcohol, cigarettes, and drugs
• Withdrawing from social interactions and other activities
• A change in appetite
• A change in sleeping patterns

Because stress affects your body and mind on so many levels, it can also exacerbate any other conditions you might have. If you have any mental health conditions, such as depression, PTSD, or anxiety, stress might increase the intensity of your symptoms.
Autoimmune conditions can also be triggered or worsened by stress. People with fibromyalgia, for example, might experience flare-ups and increased pain when they’re stressed. Issues like eczema or herpes can also flare up during times of stress.
Chronic stress can increase your chances of developing certain conditions, according to Herbert, including high blood pressure, depression, anxiety, and an increased risk for heart disease and diabetes. Heathman also notes that chronic stress can cause the breakdown of proteins, muscle wasting, and decreased bone formation.

Is stress causing me to feel ill?

The above physical symptoms can be caused by a range of different issues, not just stress. So when your back hurts or you feel fatigued, how do you know whether it’s a symptom of stress?
“If the symptoms do not correlate clearly with anxiety, first discuss the symptoms with a primary care physician,” Heathman says. “If no physical cause is found, consult with a psychiatrist or psychologist for diagnosis and treatment options.” Hall notes that she has patients wear a device so that she can figure out whether they are experiencing chronic stress and what their stress triggers are.
Herbert also recommends keeping a journal and recording your stressors and symptoms. “Answer the following questions: What causes stress in your life? How do you react to stress?” she suggests. This can help you see whether stressful situations are causing you to feel a specific way. A therapist could also help you figure out your stressors and whether you’re experiencing chronic stress. A psychologist or psychiatrist might formally diagnose you with chronic stress or with an anxiety disorder if your symptoms correlate.

How to Cope

How does one cope with stress?
Of course, there is no single, universal answer to this question. Everyone experiences stress and the symptoms of stress differently and for different reasons, which means our coping techniques will differ too.
Fortunately, there are plenty of resources and tools available for stress management. The first step, Herbert says, is to notice that you’re stressed and to work on changing your mindset. “You often can’t change the stressor but you can change the way you react or better prepare for it,” Herbert explains. She suggests using certain techniques when faced with a stressful situation. This could include practicing deep breathing each day, keeping a gratitude journal, or counting to 10 before you face a difficult situation.
Herbert also recommends implementing certain lifestyle changes to improve your body’s ability to cope with stress. This includes exercising at least 30 minutes a day three times a week, meditating for 10 to 15 minutes a day, and improving your eating. Herbert says you can improve your diet by “decreasing or discontinuing caffeine, eating a protein-rich breakfast every morning, and including fruits, vegetables, cereals, and nuts in the diet.”
Heathman takes a two-step approach to dealing with stress: “The first way to reduce the sympathetic [flight-or-fight] response is by participating in relaxation techniques like meditation, deep breathing exercises, and visualization techniques,” he says. “The second option is to harness the benefits of the sympathetic nervous system by participating in healthy exercise. This can include jogging, yoga, weightlifting, and sexual activity.”
When your body is in flight-or-fight mode, it’s the perfect opportunity to exercise. Think about it: Your body is essentially getting ready to run or attack the cause of stress, meaning it’s in a good state to try some physical activity.
“After expending significant amounts of energy, the body knows to upregulate the parasympathetic branch of the autonomic nervous system to rest and promote the accumulation of more energy to handle future stressors,” Heathman says.

Do I need professional help?

You might wonder whether your symptoms are “bad enough” to warrant therapy, but seeing a therapist can help you get a handle on stress before your symptoms become unbearable. In this way, professional help can be a pre-emptive strike.
Seeing a therapist of some kind can help you build skills and use techniques that will help you keep your stress in check. This can enable you to deal with stress directly, nipping it in the bud before it affects your physical and emotional health.
One sure-fire sign that you definitely need help? If you feel that the stress is affecting your mental health, it’s important to seek professional help, says Herbert. This is especially true since chronic stress can cause depression and anxiety. Herbert says that the following signs suggest you should see a therapist:

• Eating too much or not having interest in food, which may cause weight gain or weight loss
• Sleeping too much or too little
• Feeling extremely fatigued
• Persistent feelings of sadness or loneliness
• Loss of interest in things that once brought you joy
• Having suicidal thoughts or attempts to hurt yourself
• Constant lack of concentration

Stress is inevitable, but with a good support network, stress-management skills, and perhaps professional help, it can be managed.
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