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ThePsychiatricandDental
Interrelationship
BhartiTomar*,NavneetKaurBhatia**,PankajKumar***,M.S.Bhatia***,RupalJ.Shah*
*GovernmentDentalCollegeandHospital,Ahmedabad
**SantoshDentalCollegeandHospital,Ghaziabad
***UCMS,GTBHospital,DilshadGarden,Delhi110095

Oralhealthisanintegralpartofgeneral
health.Thereisevidencethatpatientssufferingfrom
mentalillnessaremorevulnerabletodentalneglect
andpoororalhealth1.Simsreportedthatphysical
healthproblemsaremorecommoninpsychiatric
patients2.Theyseemtobepoorlyrecognizedby
psychiatrists,andoralhealthisnoexception.
Psychiatricdisordersaffectthegeneralbehaviour
ofaperson,impairleveloffunctioningandalter
perceptiontowardsoralhealth.Eatingandsleeping
patternstakeprecedenceoverpersonnelhygiene,
makingthemsusceptibletomanyoraldiseases.
Alternatively,oralsymptomsmaybethefirst
oronlymanifestationofamentalhealthproblem
e.g.,facialpain,preoccupationwithdentures,
excessivepalatalerosionorselfinflictedinjury.
Thetwodiseaseswhichhaveamajorimpacton
theoralcavityaredentalcaries(toothdecay)and
periodontaldisease(gumdisease).Dentistsspend
aconsiderableamountoftimetreatingpatientswho
presentwitheitherpsychiatricdisorderslike
depressionandanxietyorwithphysicalmanifesta
tionsofunderlyingemotionaldisturbances.
Commonmanifestationsofcovertemotional
disturbanceinpatientsindentalpracticeinclude
oraldysaesthesia,atypicalfacialpainandother
atypicalsyndromes3.Increasingattentionneedsto
begiventoidentifyandappropriatelytreat
somatoformdisorders,moreso,astheyconstitute
onethirdtoonehalfofreferralstoanyliaison
psychiatryservice4.
Somatoformdisorders,apartfromposing
managementproblems,alsocausesignificant
functionalimpairmentandoveralldisabilityforthe
patient5.Bassetal6recognizedsomatoform
disordersasseverepsychiatricdisordersand
suggestedthattheybetreatedbypsychiatristsor
psychologists.
Recognizablepsychopathologyisseeninup
to30%ofpatientsattendingdentalclinics7andthis
oftengoesundetectedandhenceuntreated.Dental

specialists,oftencomeacrosspatients,whopresent
withcomplaintsofpain,abnormalitiesofsensation,
movementandsalivationinvolvingthemouthand
face,whichareamanifestationofunderlying
emotionaldisturbanceandnotduetoaclearly
identifiablephysicalcause.Earlyandappropriate
recognitionofsuchemotionaldistresswouldbenefit
boththeindividualandthehealthservice8.
Giventheprevalenceandimpactof
unrecognizedanduntreatedpsychiatricdisorders
inpatientspresentingindentalpractice,there
followstheneedforaservicetoaddressthisunmet
need.Thiswoulddirectlyprovideaframeworkfor
psychiatricdentalliaisonandindirectlyleadto
betterunderstandingofpsychiatricdisordersby
dentalspecialists,whichinturnwillleadtoearly
identificationandreferraltosuchaserviceifone
exists.Ithasbeenshownelsewhere9thatavailability
ofpsychiatricliaisonservicewillleadtoanincrease
inrateofreferrals.
TypesofMajorDentalConditions
Recognitionofadentalproblemdoesnotmean
thattheappropriateactionwillbetaken.Asanaid
todecisionmaking,thefollowingsectionprovides
abriefoverviewofthemainoraldiseasesand
conditions
Dentalcaries
Dentalcariesisthediseaseprocesswhich
destroysthehardlayersofteeth.Itistheresultof
thedemineralizationofenamelanddentineby
acidsproducedasbyproductsofthemetabolismof
fermentablecarbohydratesbydentalplaque
microorganisms.Thisresultsincavitationof
specificsitesonthetoothsurfaceandasa

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consequenceproducespainandunsightlyteeth.
Goodoralhygienealoneisnormallyinsufficientto
preventtoothdecay.Treatmentofdentalcaries,
onceithasproducedacavity,involveseitherthe
restorationorextractionofaffectedteeth.The
incidenceofmissingteethishigher(38.57%)
amongstudygroupand37.79%incontrols10(isin
agreementwithotherstudies11,12.,indicatingthere
israpidprogressofcariestoapointwhere
extractionbecomesnecessary.
Periodontaldisease
Periodontaldiseaseonlyoccursinthepresence
ofdentalplaque.Initiallythediseasecauses
inflammationofthegingivaeandatthisstagethe
processisreversible.Ifitprogressestodestroythe

periodontaltissue(periodontitis),thisis
irreversible.Ifallowedtoprogressunchecked,
periodontitiswillresultintoothloss.Preventive
strategiesmainlyinvolvereducingdentalplaque
levelsbyimprovedoralhygienetechniques.Asthe
initialstagesofthediseasearereversible,early
interventiontoimproveoralhygienegivesthe
greatestbenefit.Druginducedovergrowthsof
gingivaearecommonduetopharmacologic
drugs(antiepilepticslikephenytoin),whichcreates
favourableconditionforretentionofplaque,
creatingaviciouscirclewhichenhancesthe
gingivalinflammationandultimatelylossoftooth
ifunrecognizedanduntreated.
Oralcancer
Theprevalenceoforalcancerincreaseswith
ageand98%ofcasesoccurovertheageof40years.
Themajorcausesoforalcanceraresmoking,
chewingtobaccoandalcoholconsumption.
Addressingtheseaspectsarethebasisofa
preventivestrategy.Thedetectionofprecancerous
lesionsinthemouthbringsmajorbenefits.It
improvesthesurvivalrateandreducesthedistress
associatedwithsomeformsofradicalsurgeryor
radiotherapy.Canceroftheheadandneckaffects
thepsycheaswellasthesomaand,assuchcalls
foracomprehensiveapproachtotreatment.
Psychiatristsanddentistsshouldbeawarethat
patientsnormallyreacttothephenomenonofcancer
asagrievouseventandexperienceemotionssuch
asdenial,depression,anxiety,guiltandfear.
Locatinginthehighlyvisibleareaandpersonally
identifyingplace,headandneckcancerhasserious
socialconsequencesandevokessymbolicsexual
conflicts.
Toothwear
Toothweartendstoincreasewithage.Itmay
becausedbyattrition(whichistheactionofone
toothgrindinguponanother),abrasion(wherethe
toothsurfaceiswornbyanotheragent,forexample,
atoothbrush)orerosioninwhichthereischemical
dissolutionofthetooth.Amajorfactorinthe
erosionoftoothenamelanddentineisan
excessivelyacidicdiet,notablycitrusfruitsand
carbonateddrinks.Somestudieshaverecordedover
40%ofsometoothsurfacesaffectedbyerosion
associatedwithdietaryacids13.Attentiontodietis
themainfocusforthepreventionoftootherosion.
Theclinicalfeaturesofanorexianervosaincludes
apatternofenameldissolutionincasesofvomiting,
regurgitation,and/ortheconsumptionoflarge
amountsofcitrusfruits;andanalteredcaries
responseduetoabnormalcarbohydrateconsump
tion.Despitethepatientsprobablyinsistentdenial
ofanorecticeatinghabits,dentistshouldconsider

theexistenceofanorexianervosainthepresence
ofsuchabnormalfeatures,especiallyinyoung
women.Whereasthesomaticchangesoccurring
withanorexianervosaarereversible,thoseaffecting
theharddentaltissuesarenot.
ThetermperimolysisisusedbyHoistand
Lange14todescribethedestructionoftoothtissue
duetopersistentvomiting.Casesofdentaldamage
resultingfromregurgitationorvomitingas
symptomsofsuchmedicalconditionsashiatus
hernia,gastricdysfunction,duodenalorpeptic
ulcer,antabusetherapyforalcoholism,andduring
pregnancyarewelldocumented.
Xerostomia,SialorrhoeaandotherDisorders
Salivaplaysanimportantroleinoralhealth.It
containsglycoproteinsandmucoproteinswhich
lubricatetheoralcavityandenhancefoodbolus
formation,translocationoffoodandinitiationof
swallowing.Italsocontainsperoxidasesand
lysozymeswhichhaveantibacterialproperties.
Salivabuffersandneutralizesacidsproducedby
bacteriafromfoods.Salivaalsofacilitatesthe
articulationofspeech.Xerostomia(reduced
salivaryflow)hasbeenimplicatedinarangeof

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dentalconditions.Stiefeletalfoundincreased
plaque,calculusformation,caries,gingivitisand
softtissuelesionsinpeoplewithreducedsalivary
flow.Individualswithxerostomiawerealsofound
tobeatgreaterriskofrootandcoronalcaries
formation14.Theeffectwasincreasedwhenmultiple
typesofmedicationwithxerostomicsideeffects
weretaken.Xerostomiaalsopredisposestooral
candidiasis,especiallyindenturewearers.
Xerostomiacanbeinducedbymedicationwith
anticholinergicsideeffectsbytricyclicantidepress
ants,otherantidepressants(e.g.selectiveserotonin
reuptakeinhibitors),lithiumcarbonate,butyro
phenones,Phenothiazines,Sedatives(including
benzodiazepines),antihistamines,antihypertensi
ves,anticholinergicdrugs,diuretics15etc.Some
autoimmunediseases,forexampleSjogrens
syndrome,andexposuretooralradiationmaycause
severexerostomia.Sialorrhoea,whichistheover
productionofsaliva,isbothunpleasantforthe
patientandforothers,leadingtodroolingand
sorenessoftheface.Sialorrhoeaisawellknown
sideeffectofclozapineandmayimproveafter
reductioninthedose.Ifclozapinehastobe
continued,itispossibletotreatthesialorrhoeausing
anticholinergicmedication.

InadditiontoXerostomiaandSialorrhoea,
medicationcanproduceavarietyofotherside
effectsrelevanttodentistrye.g.Abnormalfacial
movements,Tics,Grimacing,Orofacialdyskinesia,
Parkinsoniansideeffects,Gingivalhyperplasia.
Psychiatricdisordersaffectingdentalhealth
Dentalanxiety
Inthegeneralpopulation,psychological
problemsrelatingtoreceivingdentaltreatmentare
widespread.Ithasbeenreportedthatabouthalfof
alldentalpatientsexperiencesomeanxietytowards
theirdentalvisits16.Itisimportanttorecognizethe
rolethatdentalfearplays,asitcanleadtodelayin
seekingnecessarydentaltreatment,cancellationof
appointmentsandpoorcooperationinthedental
chair.Dentalfearisoneofthemosttroublesome
patientmanagementproblemsforthedentalteam,
causesdistressforthepatientandresultsinhigh
stresslevelsindentists.
Dentalphobia
DentalphobiaisclassifiedinDSMIV
(AmericanPsychiatricAssociation,1994)asa
specificphobia,whichinvolvesamarkedand
persistentfearofaspecificobject,activityor
situationthatresultsinanxietyonconfrontingthe
phobicstimulus.Dentalphobiaisclassifiedasa
specific(isolated)phobiainICD10(WorldHealth
Organization,1992).Peoplewithdentalphobia
usuallyreporttwotypesofexperiences;apainful
ortraumaticdentalprocedureornegativepersonal
interactionwithdentalstaff,ofteninchildhoodor
adolescence.Theremayalsobefearfulattitudes
learnedfromparentsandothers,afeelingoflack
ofcontrolinthedentalsituationandthepresence
ofgeneralanxietydisorders16.
Dentalpractitionersmaytreatdentalphobia
themselvesorenlistthehelpofthepatientsgeneral
practitionerorapsychiatrist.Itisveryimportant
forthedentisttounderstandthepatientsfearsand
toexplainthenatureoftheproposeddental
treatment.Ithasbeenreportedthatpeoplewith
specificfearssuchasgaggingandneedlephobia
respondbesttogradedexposureinvivoandmay
alsofindrelaxationtechniquesenablethemto
accepttreatment.Relapserateswerefoundtobe
betterinthosewhohadaboutfourhoursoftherapy.
Thosewithnonspecificfeartendtoremainvigilant
andrespondlesswelltobehaviouraltechniques.
Somedentalpractitionersofferpatientsa
mixtureofnitrousoxideandoxygentoinhale
(conscioussedation),whichproducesanalgesiaand
relaxation.Intravenousdiazepamcanbeusedfor
tranquillization,andmusic,togetherwithother
distractiontechniques,mayhelpothers.Relatively

fewpatientswillrequirespecialistcare.Thosewith
severesymptomsshouldhaveathorough
assessmentbyanexperiencedpsychologistor
psychiatristandacarefullystructuredtreatment
programme.Dentalanxietymay,ofcourse,bepart
ofanothertypeofanxietydisorder.
Generalizedanxietydisorder,panicdisorderor
agoraphobiamayalsopresentwithsomefeatures
ofdentalanxiety17.Mooreetal18describe
embarrassmentandfearwithavoidance,whichis
similartosocialphobia.
Psychosis
InaDanishstudyofhospitalpatientswith
schizophrenia,thedentalattendancewashalfthat
ofthenormalpopulation19.Toothbrushingwas
downbyathird,indicatingpoorerdentalhealth
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behaviour.Dentalproblemsmaybeassociatedwith
bothpositiveandnegativesymptomsof
schizophrenia.Teetharesometimesincorporated
intodelusionsandhallucinations.Theseinclude
delusionsofpain,oralinfestationbywormsor
insectsorbizarredelusions.Somaticdelusions
aboutpainorothersymptomsintheoralcavitymay
resultinunnecessarytreatment.Bridges,crowns,
fillingsorextractionsmaybedone,beforethe
psychiatricproblemisrecognized.Selfmutilationis
rareandmayrangefromminorabrasionstoself
extractionofteethandglossectomy.Onepatient
removedallhisamalgamfillingswithawatch
makersscrewdriverinthebeliefthattransmitters
wereinhisteeth.Dentistneedstorecognizethe
disorderandproperreferralbemade.
Eatingdisorders
Dentistshavearoleintheearlydiagnosisof
eatingdisordersastheymaybethefirsttoobserve
theeffectsoftheillness.Anorexianervosareduces
serumcalciumlevels,predisposingtoerosionof
toothenamelandcariesformation.Vitamin
deficienciesmaycausebleedinggums,angular
cheilosisandaredsoretongue.Inbulimianervosa,
largequantitiesofsoftsweetfoodsareoften
consumedandvomited.Acidicgastricjuiceserode
thelingualaspectoftheanteriormaxillaryteeth.
HazeltonandFaine20reportedthatuptoonethird
ofpeoplewithbulimiahadanteriortootherosion.
Toreduceabrasionofteethandgingivae,itis
recommendedthatamouthwashcontainingfluoride
isusedinsteadoftoothbrushingaftervomiting.

Dentalpractitionerswithspecialexperienceshould
beavailabletotreatpatientsinaneatingdisorders
service.Dentalrestorations,includingcrowns,a
fixedprosthesisororthodonticappliancesare
damagedbygastricacid.Therefore,thepatient
shouldbemotivatedandberecoveringfromtheir
illnesswellbeforebeinggivenexpensivecosmetic
dentaltreatment.
Alcoholandsubstancemisuse
Thosewhoaredependentondrugsoralcohol
oftenneglecttheirpersonalhygieneanddietary
needsandmayliveinpoorsocialconditions,allof
whichcontributetopoororalhealth.Bruxism(tooth
grinding),gingivitisandtoothabscessesaremore
commoninthosewithalcoholdependency.
Smokingcigarettesanddrinkingalcoholincrease
theriskofcarcinomaoftheoralcavity.Thosewho
takeillicitopioidsmayrequiremoreanalgesiathan
expected.Thisgroupofpatientsarequitedifficult
totreatastheyoftenpresentinanemergencywith
thediseaseprocessinamoreadvancedcondition.
Dentalhealthbehaviour
Regularbrushingwithatoothpastecontaining
fluorideisimportant,asistheavoidanceoffrequent
intakesofcariogenicfoodordrink.Alcoholand
smokingareriskfactorsfororaldisease.Special
careisneededforthosetakingmedicationwith
xerostomicsideeffects.Liquidformsofmedication
withoutsugarshouldbechosen,wheneverpossible.
Gooddenturecareshouldbepartofroutinephysical
care.Lucas21reportedthatpsychiatricpatientswho
woredentureshadmoreoralinfectionsof
candidiasis,stomatitisandangularchielosisthan
controlsubjectswhodidnotweardentures.These
painfulconditionswereworseinthosewhowore
denturesatnight.Overhalfthefemalesinthestudy
woretheirmaxillarydenturesatnight.Itis
recommendedthatalldenturesareremovedatnight
andcleanedbeforeuse.
Dentalservices
Therehavebeenmajorchangesinthewayin
whichdentalhealthservicesandtreatmenthave
beenprovidedsincetheinceptionoftheNational
HealthServicein1948.Significantadvanceshave
beenmadeinpaincontrol,dentalmaterialsand
treatmentmodalities.Insteadofgeneralanaesthesia
forextractions,thereisnowwidespreaduseof
sedationandlocalanaesthesia.Therearealsoa
varietyoftechniquesfortreatingpeoplewithdental
fearorphobia.Inthelate1950sthehighspeeddrill
revolutionizedthedeliveryofrestorativedental
treatmentandsoanincreasingproportionofthe
populationretainedtheirteethratherthanhaving
extractions.Themorerecentdevelopmentof

adhesivefillingmaterialshasfurtherimprovedtooth
restorationandnewveneertechniqueshave
increasedtheoptionsforcosmeticdentistry.The
abilitytoanchorprosthesesdirectlytothejawbone,
asaresultofthedevelopmentofosseointegrated
implants,isamajoradvance.Paradoxically,while
thenumberofdentalpractitionershassteadily
grown,theincreasedcomplexityandrangeofcare

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hasreducedthegeneralavailabilityofdentalcare
inthepopulation.Thefollowingsuggestionsare
madetoimproveoralhealthstatusofthepsychiatric
patients22,23.
Specificpreventivedentalprogramsshould
bemadeanintegralpartofpsychiatric
treatmentandcare.
Thedentalinspectionandtreatment
protocoloftroopsshouldbecarriedout
meticulously.
Applicationofappropriatepreventive
measuresliketopicalfluorideapplication,
fluoridemouthrinsesandchlorhexidine
mouthrinses.
Bettercoordinationbetweenmedical,
dentalandpsychiatricunitadministration
toservetheneedsofthisgroupofpatients.
References
1.StiefelDJ,TrueloveEL,MenardTW,etal.
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andwithoutchronicmentalillnessincomm
unitysettings.SpecialCareDentistry1990;10
:612.
2.SimsA.Whytheexcessmortalityfrom
psychiatricillness?BMJ1987;294:986987.
3.FeinmannC,HarrisM.Psychogenicfacialpain
managementandprognosis.Part1.TheClinical
Presentation.BrDentalJ1984;156:2058.
4.KatonW,RiesRK,KleinmanA.Part11:a
prospectiveDSM111studyof100consecutive
Somatisationpatients.ComprPsychiatry1984;
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5.HillerW,RiefW,FichterM.Howdisabledare
patientswithSomatoformdisorders?GenHos
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6.BassC,PevelerR,HouseA.Somatoform
Disorders:Severepsychiatricillnesses
neglectedbyPsychiatrists.BrJPsychiatry
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7.FeinmannC(ed).Themouth,thefaceandthe
mind.Oxford:OxfordUniversityPress,1999.
8.BridgesK,GoldbergDP.Somaticpresentations
ofpsychiatricillnessinprimarycaresettings.
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9.SenskyT,GreerS,CundyTetal.Referralsto
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10.GowdaEM,BhatPS,SwamiMM.Dental
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12.SjorgrenR,NordstromG.Oralhealthstatusof
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15.RemickRA,BlasberyB,PattersonBD,etal.
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16.SlovinM.Managingtheanxiousandphobic
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17.EnochD,JaggerR.PsychiatricDisordersin
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DELHIPSYCHIATRYJOURNALVol.14No.1
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Ini adalah penelitian survey dengan rancangan cross sectional study yang bertujuan menilai
pengaruh gangguan cemas menyeluruh terhadap pola tekanan darah serta membandingkannya
dengan kelompok control yang tidak cemas. Diagnosa gangguan cemas menyeluruh ditegakkan
berdasarkan criteria diagnostic menurut PPDGJ III atau DCR-10.
Sasaran penelitian ini adalah semua pasien gangguan cemas yang datang berobat ke poliklinik
rawat jalan Rumah Sakit Jiwa Pusat Ujung Pandang, Sampel dirtarik secara random dengan

model penarikan cross over design.Data yang dikumpulkan diolah dan dianalisa dengan
menggunakan computer.
Dari penelitian ini didapatkan hasil 11 orang (35,5 %) pasien mempunyai tekanan darah diastolic
diatas nilai normal dan enam orang diantaranya disertai tekanan darah sistolik yang juga diatas
nilai normal. Tekanan darah rata-rata dari pasien dengan gangguan cemas menyeluruh adalah
lebih tinggi dari kelompok control yang tidak cemas.
Kesimpulan, pengaruh gangguan cemas menyeluruh terhadap pola tekanan darah secara
statistic tidak bermakna. Ada perbedaan tekanan darah antara kelompok kasus dengan
kelompok yang tidak cemas.
Kata kunci : GAD Otonomik Tekanan darah meningkat
Era globalisasi membawa dampak bagi perubahan interaksi sosial yang dapat menimbulkan
stres pada individu- individu tertentu. Stres ini dapat mempengaruhi fungsi dari berbagai system
organ tubuh, terutama system kardiovaskuler.
Selye dalam teorinya General Adaptation Syndrome atau Biological Stress Syndrome,
menjelaskan bahwa pada tahap awal(reaksi alarm ) reaksi fisiologik terhadap stres adalah
peningkatan aktivitas dari simpatetik adrenomedular merangsang sekresi adrenalin yang akan
menyebabkan peningkatan darah sistolik kemudian pada tahap kedua ( tahap perlawanan)
terjadi peningkatan aktivitas dari simpatetik adrenokortikal mengsekresi noradrenalin,
kortisol,aldosteron yang akan menyebakan peningkatan tekanan darah baik sistolik maupun
diastolik. Dan pada tahap ketiga ( tahap kelelahan), segala energi telah habis, tubuh menjadi tak
berdaya, organ- organ tubuh rusak, tekanan darah menurun dan pada akhirnya dapat membawa
kematian (1,2).
Manifestasi dari stress yang berkepanjangan dapat berubah anxietas (2,3). Anxietas adalah
suatu keadaan ketakutan tanpa adanya objek yang jelas. Respon fisiologik dijelaskan oleh
cannon (4).
Menurut cannon, anxietas akan menimbulkan fight or flight. Flight merupakan reaksi isotonik
tubuh untuk melarikan diri, dimana terjadi peningkatan sekresi adrenalin kedalam sirkulasi darah
yang akan menyebabkan meningkatnya denyut jantung dan tekanan darah sistolik , sedangkan
fight merupakan reaksi agresif untuk menyerang yang akan menyebabkan sekresi noradrenalin,
rennin angiotensin sehingga tekana darah meningkat baik sistolik maupun diastolic (5).
Salan (6) meyatakan bahwa pada anxietas sedang terjadi sekresi adrenalin yang berlebihan
sehingga menyebabkan tekanan darah meningkat ,akan tetapi pada ketakuatn yang sangat
hebat bisa terjadi reaksi yang dipengaruhi oleh komponen parasimpatis sehingga menyebabkan
tekanan darah meningkat, akan tetapi pada ketakutan yang sangat hebat bisa terjadi reaksi yang
dipengaruhi olehj komponen parasimpatis sehingga menyebabkan tekanan darah menurun.
Dari berbagai penelitian klinik yang pernah dilakukan mengenai pengruh stress atau anxietas
terhadap tekanan darah didapatkan hasil yang berbeda-beda. Sebagian besar peneliti
menemukan adanya peningkatan tekanan sistolik sebagi akibat dari peningkatan curah jantung
dan denyut jantung (7,8,9), sedangkan yang lainnya menemukan peningkatan tekanan diastolic
(10) dan ada juga yang tidak menemukan hubungan antara keduanya (11).
Pada penelitian yang membandingkan tekanan darah dari orang-orang yang menderita stress
atau anxietas dengan orang-orang yang tidak menderita stress atau anxietas didapatkan hasil
tekanan darah yang lebih tinggi pada kelompok penderita stress (12,13).
Adanya hasil yang berbeda-beda mengenai pengaruh anxietas terhadap tekanan darah ini
mendorong kami untuk melakukan penjelitian bagaimanakah pola tekanan darah pada gangguan

cemas menyeluruh yang merupakan salah satu bentuk daria anxietas dan bagaimana
perbandingannya bila dibandingkan dengan orang yang tidak cemas.]
Dipilihnya topik ini adalah karena :
1.
Gangguan cemas menyeluruh merupakan gangguan anxietas yang prevalensasinya
cukup besar (3-8%).
2.
Gangguan cemas menyeluruh perjalanan penyakitnya kronis dan derajat
kecemasannya relative stabil.
3.
Adanya komplikasi kardivaskuler akibat stress atau anxietas yang mungkin dapat
membawa kematian.
Tujuan Penelitian
Penelitian ini bertujuan untuk :
1.
Menilai pengaruh dari gangguan cemas menyeluruh terhadap tekanan darah baik
sistolik maupun diastolic.
2.
Menilai apakah ada perbedaan tekanan darah antara penderita gangguan cemas
menyeluruh dengan kelompok control yang tidak cemas.
TINJAUAN PUSTAKA
A. ANXIETAS
Sejarah
Dari studi kepustkaan yang dibuat oleh Lewis pada tahun 1970, ditemukan bahwa istilah
anxietas mulai diperbincangkan pada permulaan abad ke-20. Kata dasar anxietas dalam bahasa
Indo Jerman adalah angh yang dalam bahasa latin berhubungan dengan kata angustus,
ango, angor, anxius, anxietas, angina. Kesemuanya mengandung arti sempit atau
konstriksi(13).

Pada tahun 1894, Freud menciptakan istilah anxiety neurosis. Kata anxiety diambil dari kata
angst yang berarti ketakutan yang tidak perlu(4). Pada mulanya Freud mengartikan anxietas
inu sebagai transformasi lepasnya ketegangan seksual yang menumpuk melalui system saraf
otonom dengan menggunakan saluran pernafasan. Kemudian anxietas ini diartikan sebagai
perasaan takut atau khawtir yang berasal dari pikiran atau keinginan yang direpresi. Akhirnya
nxietas diartikan sebagi suatu respon terhadap situasi yang berbahaya (4).
Definisi
Anxietas merupakan pengalaman yang bersifat subjektif (6,14,15,16), tidak menyenagkan
(4,6,16,17). tidak menentu (4.6.17,18), menakutkan dan mengkhawatirkan akan adanya
kemungkuna bahaya atau ancaman bahaya (16,17), dan seringkali disertai oleh gejala-gejala
atau reaksi fisik tertentu akibat peningkatan aktifitas otonomik (4,6,16,18).
Klasifikasi
Menurut Diagnostic and Statistical Manual of Mental Disorder IV (DSM IV) terbagi atas :
1.
Gangguan Panik dengan atau tnpa agorafobia.
2.
Agorafobia tanpa riwayat gangguan panic.
3.
Fobia Spesifik.
4.
Fobia Sosial.
5.
Obsesi kompulsif.
6.
Gangguan stress pask trauma.
7.
Gangguan Cemas Menyeluruh(Generalized Anxiety Disorder).

8.
Gangguan Cemas karena kondisi Medis Umum (Anxiety Disorder Duwe To Medical
Condition).
9.
Gangguan cemas yang disebabkan oleh subtansi zat (Subtance Induced Anxiety Disorder).
dalam ICD-10(20), anxietas dimasukkan dalam kelompok Gangguan Neurotik, gangguan yang
berhubungan dengn stress dan Simatoform. Kelompok ini terbagi dalam :
1.
Gangguan Anxietas Fobik yang terdiri atas :
a. Agorafobia dengan atau tanpa gangguan panic.
b. Fobia Sosial.
c. Fobi Spesifik.
2.
Gangguan anxietas yang lain (Other Anxiety Disorder) yang terdiri atas :
a. Gangguan Panic(Panic Disorder).
b. Gangguan Cemas Menyeluruh (Generalized Anxiety Disorder).
c. Gangguan Campuran Anxietas dan Depresi ( Mixed Anxiety Disorder).
3.
Gangguan Obsesi Kompulsif.
4.
Gangguan Reaksi Menuju ke Stres Berat dan Gangguan Penyesuaian (Reaction to Severe
Stress, and Adjusment Disorder).
B. GANGGUAN CEMAS MENYELURUH
Definisi
Menurut DSM-IV yang dimaksud gangguan cemas menyeluruh adalah suatu keadaan ketakutan
atau kecemasan yang berlebih-lebihan, dan menatap sekurang-kurangnya selama enam bulan
mengenai sejumlah kejadian atau aktivitas disertai oleh berbagai gejala somatica yang
menyebabkan gangguan bermakna pada fungsi sosial, pekerjaan, dan fungsi- fungsi lainnya
Sedangkan menurut ICD-10 gangguan ini merupakn bentuk kecemasan yang sifatnya
menyeluruh dan menatap selam beberapa minggu atau bulan yang ditandai oleh adanya
kecemasan tantang msa depan, ketegangan motorik, dan aktivitas otonomik yang berlebihan.
Epidemiologi
Gangguan cemas menyeluruh merupakan gangguan nxietas yang paling sring dijumpai, diklinik
diperkirakan 12 % dari seluruh gangguan anxietas. Prevalensinya di mas7yarakat diperkirakan 3
%, dan prevelansi seumur hidup (life time) rata-rata 5 % (19) .Di Indonesia prevalensinya secara
pasti belum diketahu, namun diperkirakan 2 % -5% (21).
Gangguan ini lebih sering dijumpai pada wanita dengan ratio 2 : 1, namun yang datang meminta
pengobatan rationya kurang lebih sama atau 1 :1 (4).
Etiologi
Etiologi dari gangguan ini belum diketahui secar pasti, namun diduga dua faktor yang berperan
terjadi di dalam gangguan ini yaitu, factor biologic dan psikologik (4 ,22).
Faktor biologic yang berperan pada gangguan ini adalah neurotransmitter. Ada tiga
neurotransmitter utama yang berperan pada gangguan ini yaitu, norepinefrin , serotonin, dan
gamma amino butiric acid atau GABA (4,14,15,22). Namun menurut Iskandar (21)
neurotransmitter yang memegang peranan utama pada gangguan cemas menyeluruh adalah
serotonin sedangkan norepinefrin terutama berperan pada gangguan panic.
Dugaan akan peranan norepinefrin pada gangguan cemas didasarkan percobaan pada hewan
primata yang menunjukkan respon kecemasan pada perangsangan locus sereleus yang
memprm,,.mmm n pemberian obat-obatan yang meningkatkan kadar norepinefrin dapat
menimbulkan tanda-tanda kecemasan, sedangkan obat-obatan menurunkan kadar norepinefrin
akan menyebabkan depresi (23,24).

Peranan Gamma Amino Butiric Acid pada gangguan ini berbeda dengan norepinefrin.
Norepinefrin bersifat merangsang timbulnya anxietas, sedangkan Gamma Amino Butiric Acid
atau GABA bersifat menghambat terjadinya anxietas ini (4,14,15,25)Pengaruh dari
neutronstransmitter ini pada gangguan anxietas didapatkan dari peranan benzodiazepin pada
gangguan tersebut. Benzodiazepin dan GABA membentuk GABA-Benzodiazepin complexyang
akan menurunkan anxietas atau kecemasan(25). Penelitian pada hewan primate yang diberikan
sutau agonist inverse benzodiazepine Beta- Carboline-Carboxylic- Acid (BCCA) menunjukkan
gejala-gejala otonomik gangguan anxietas.
Mengenai perana serotonin dalam gangguan anxietas ini didapatkan dari hasil pengamatan
efektivitas obat-obatan golongan serotonergik terhedap anxietas seperti buspiron atau buspar
yang merupakan agonist reseptor serotorgenik tipe 1A (5-HT 1A).Diduga serotonin
mempengaruhi reseptor GABA-Benzodiazepin complex sehingga ia dapat berperan sebagai anti
cemas (4,14,25).Pemungkinan lain adalah interaksi antara serotonin dan norepinefrin dalam
mekanisme anxietas sebagai anti cemas (21).
Sehubungan dengan factor-faktor psikolgik yang berperan dalam terjadinya anxietas ada tiga
teori yang berhubungan dengan hal ini, yaitu : teori psikoanalitik, teori behavorial, dan teori
eksistensial.
Menurut teori psiko-analitik terjadinya anxietas ini adalah akibat dari konflik unconscious yang
tidak terselesaikan (4,6).
Teori behavior beranggapan bahwa terjadinya anxietas ini adalah akibat tanggapan yang salah
dan tidak teliti terhadap bahaya. Ketidaktelitian ini sebagai akibat dari perhatian mereka yang
selektif pada detil-detil negative dalam kehidupan, penyimpangan dalam proses informasi, dan
pandangan yang negative terhada[p kemampuan pengendalian dirinya (4).
Teori eksestensial bependapat bahwa terjadinya anxietas adalah akibat tidak adanya rangsang
yang dapat diidentifikasi secara spesifik.Ketiadaan ini membuat orang menjadi sadar akan
kehampaannya di dalam kehidupan ini (4,5).
Gambaran Klinik
Gambaran klinik dari gangguan ini ditandai oleh adanya ketakutan dan kecemasan yang
berhubungan dengan masa yang akan datang, gejala ketegangan motorik, hiperaktivitas system
saraf otonom dan meningkatnya kewaspadan (4,19,20).
Ketegangan motorik bermanisfetasi sebagai sakit kepala, gemetar dan gelisah. Gejala
hiperaktivitas system saraf otonom berupa jantung berdebar-debar, nafas pendek, berkeringat
banyak, dan berbagai gejala system pencernaan. Meningkatnya kewaspadaan ditandai dengan
adanya persaan mudah marah dan mudah terkejut (4,19,20).
Perjalanan Penyakit
Perlangsungan dari gangguan ini bersifat kronis residif dan prognosisnya sukar diramalkan.
Sebanyak 25 % dari penderit ini mengalami gangguan panic (4).
Pengaruh Gangguan Cemas Menyeluruh terhadap Tekanan Darah.
Ada dua factor yang paling berpengaruh pada tekanan darah, yaitu curah jantung (cardiac
output) dan tahanan perifer (peripheral resistance) (26,27,28).
Kecemasan atau anxietas akan merangsang respon hormonal dari hipotalamus yang akan
mengsekresi CRF ( Cortisocoprin- Releasing Factor) yang meneybabkan sekresi hormonhormon hipofise. Salah satu dari hormon tersebut adalah ACTH (Adreno- Corticotropin Hormon).
Hormon tersebut akan merangsang korteks adrenal untuk mengsekresi kortisol kedalam
sirkulasi darah (2,15). Peningkatan kadar kortisol dalam darah akan mengakibatkan

[peningkatan renis plasma, angiotensin II dan peningkatan kepekaan pembuluh darah terhadap
katekolmin (26), sehingga terjadi peningkatan tekanan darah.
Selain itu hipotalamus juga berfungsi sebagi pusat dari system saraf otonom(15,29). Sistem ini
terbagi atas system simpatis dan system parasimpatis(23,30). Menurut Salan (26) pada anxietas
sedang terjadi sekresi adrenalin berlebihan yang menyebabkan peningkatan tekanan darah,
sedanngkan pada anxietas yang sangat berat dapat terjadi reaksi yang dipengaruhi oleh
komponen parasimpatis sehingga akan mengakibatkan penurunan tekanan darah dan frekuensi
denyut jantung. Pada kecemasan yang kronis kadar adrenalin terus meninggi, sehingga
kepekaan terhadap rangsangan yang lain berkurang dan akan terlihat tekanan darah meninggi.
Menurut Iskandar (21) pada Gangguan Cemas Menyeluruh yang terutama berperan adalah
neurotransmiter serotonin. Pada saat ini telah diidentifikasi tiga reseptor serotonin, yaitu : 5-HT 1,
5-HT2 dan 5-HT3 (23,31). Menurut Kabo(33) reseptor 5-HT1 bersifat sebagai inhibitor, sedangkan
reseptor 5-HT2 dan reseptor 5-HT3 bersifat sebagai eksitator. Menurut Gothert (31) aktivasi
reseptor 5-HT1 akan mengurangi kecemasan sedangkan aktivasi reseptor 5-HT2 akan
meningkatkan tekanan darah.
METODE
Subjek
Baik kelompok kasus maupun kelompok control diambil dari pengunjung poliklinik rawat jalan
Rumah Sakit Jiwa Ujung Pandang. Kelompok kasus dalah penderita gangguan cemas
menyeluruh sesuai dengan criteria diagnostic PPDGJ III dan DCR-10 (Diagnostic Criteria For
Research ICD-10). kelompok control adalah pengunjung poliklinik yang datang untuk
mendapatkan surat keterangan sehat dan bebas narkotik yang tidak cemas menurut HARS
( Hamilton Anxiety Rating Scale). Yang diamsukkan dalam penelitian ini adalah berusia 18 tahun
atau lebih, tidak menderita psikotik , tidak ada riwayat hipertensi dan gangguan lain yang dapat
meningkatkan atau menurunkan tekanan darah seperti Diabetes, hipertiroid, penyakit ginjal,
anemia dsb.
Prosedur
Mula- mula dilakukan pengukuran tekanan darah baik terhadap kelompok kusus maupun
kelompok control. Pengukuran dilakukan dalam posisi duduk setelah istirahat selama lima menit.
Kemudian dilakukan wawancara untuk menegakkan diagnosis dan menilai derajat kecemasan
dengana menggunakan criteria diagnostic menurut PPDGJ III atau DCR-10 dan HARS.
Pengolahan data
Pengolahan data dilakukan secara elektronik dengan mengguna-kan computer melalui paket
statistic yang ada dalam program epi info versi 6, dan analisisnya dilakukan dengan
menggunakan SPSSpc+.
Uji statistic yang digunakan adalah Kai kuadrat untuk uji kemaknaan gangguan cemas
menyeluruh terhadap tekanan darah dan student t test tidak berpasangan untuk meliht adanya
perbedaan tekanan darah antara kelompok kasus dengan kelompok control yang tidak cemas.
HASIL PEMBAHASAN
Selama penelitian ini telah diobservasi sebanyak 62 orang yang terdiri dari 31 orang kelompok
kasus dan 31 orang kelompok control.
Kebanyakan dari penderita gangguan cemas menyeluruh yang berkunjung ke poliklinik tersebut
adalah laki-laki(21 orang atau 64,5 %), dengan ratio 2 : 1 , sedangkan menurut literatur
(4,19,21,22) gangguan tersebut lebih banyak diderita oleh wanita dengan ratio 2 : 1, namun
yang datang berobat ke dokter rationya kurang lebih sama (1 : 1). Mungkin hal ini disebabkan

oleh karena sifat wanita yang kurang terbuka pada orang lain ataukah karena aktivitasnya yang
lebihbanyak untuk megurus rumah tangga, apalagi pada masyarakat timur.
Sebagian besar dari penderita gangguan tersebut adalah pengangguran (48,4 %) dan pada
umumnya merupakan kelompok usia dewasa muda (21-40 tahun) sebanyak 16 orang atau 51,6
%, dan dewasa pertengahan (41- 65 tahun) sebanyak 11 orang atau 38, 7 %. Ketiadaan
pekerjaan membawa individu kepada hampaan dalam kehidupan yang merupakan factor
psikososial bagi timbulnya kecemasan, sebagaimana dikemukakan dalam teori eksistesial (4,6).
Pada umumnya tekanan darah dari penderita gangguan cemas menyeluruh dalam batas normal,
hanya 11 orang atau 35,5 % yang mempunyai tekanan darah diatas batas normal. Semua dari
penderita yang tekanan darahnya diatas batas normal ini mempunyai tekanan diatolik 90 mmHg
keatas dan enam diantaranya mempunyai mempunyai tekanan sistolik 140 mmHg keatas.
Meskipun pada penelitian ini didapatkan adanya kenaikan tekanan darah sesuai dengan
meningkatnya kecemasan sebagi man dalam literature (7,8,910), namun pengaruh dari
gangguan dari anxietas ini secara statistic tidak bermakna.
Setelah dilakukan uji statistic dengan menggunakan student t test perbedaan tekanan darah
antara kelompok kasus ( sistolik rata-rata 118,7 mmHg dan diastolic 79,8 mmHg) dengan
kelompok control ( sistolik rata-rata 111,7 mmHg dan diastolic 71,00 mmHg), didapatkan hasil
adanya perbedaan yang bermakna secara statistic lebih tinggi pada kelompok kasus.
KESIMPULAN
Gangguan cemas menyeluruh lebih banyak diderita oleh kelompok dewasa muda dan umumnya
tidak mepunyai pekerjaan.
Meskipun gangguan anxietas ini secara statistic tidak mempengaruhi tekanan darah, namun
35,5 % dari penderita pada penelitian ini mempunyai tekanan diatolik diatas normal.
Tekanan darah penderita gangguan cemas menyeluruh secara bermakna lebih tinggi dari
kelompok yang tidak cemas.
SARAN
1.
Karena pengangguran (ketiadaan pekerjaan) tidak hanya menimbulkan dampak sosial
yang buruk tetapi juga dapat mengakibatkan gangguan psikis pada akhirnya mungkin dapat
menyebabkan penyakit fisik, perlu kiranya kerjasama yang baik antara berbagai pihak yang
terkait dalam masalah ini.
2.
Sekalipun pengaruh gangguan cemas menyeluruh terhadap tekanan darah secara statistic
tidak bermakna, namun adanya penderita dengan tekanan diastolic diatas batas normal yang
jumlahnya cukup besar (35,5%), perlu kiranya diwaspadai adanya komplikasi hipertensi dimasa
yang akan datang dan perlu penanganan yang baik untuk gangguan cemas maupun
hipertensinya.
3.
Menyadari akan adanya kekurangan-kekurangan dalam penelitian ini baik dalam segi
prasarana maupun metode dan jumlah sample yang kecil. Perlu kiranya dilakukan penelitian
dengansampel yang lebih besar dan dengan prasaranan yang lebih baik.
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Baltimore USA, 1994, 573-616.
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10. Steproe A, Melvile D, Ross A : Essential Hypertension And Psychological Functioning. A
study of factory workers, Br J Clinical Psychol 1982, 21 : 303 311`.
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Secluded Order, J hypertensions 1985,3 (supplemen 8), 5387 -5388.
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Dalam Anxietas ,K. Setyonegoro dan Y. Iskandar (ed). Yayasan Dharma Usada , Jakarta, 1980.
45-43.
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Blackwell Scientific Publication . London, 1989, 394 -427.
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Cataloging in Publication Data Silverstone Trevor, London, 1993, 182- 200.
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USA,1974, 216-218.
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2 nd ed, Houghton Mifflin Company, Boston, USA, 1985, 170-259.
19. American Pshyciatryc Association : Anxiety Disorder, Diagnostic and Statistical Manual of
Mental Disorder IV (DSM-IV), Washington , USA, 1994.
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Disorders and Behavior Disorders, Geneva, 1994.
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22. Sharma R. : Anxiety state, In Pshyciatri Diagnosis & Therapy 88/89, JH Flaherty (ad),
Prentice Hall International Inc. USA, 1989, 84-95.
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Cambridge University Press, USA, 1996, 168 -215.
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University Press, USA, 1996 , 168-215.
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Pengobatan, Simposium Nasional Hipertensi, PB IDI, Jakarta ,1993.
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Sidabutar (ed), Yayasan Penerbitan IDI,Jakarta,1991.
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29. Adams RD. : The Limbic Lobes and the Neurology of Emotions. In Princeples Neurology,
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http://www.essenceofstressrelief.com/

Hans Selyes
General Adaptation Syndrome
Scientist Hans Selye (1907-1982) introduced the General Adaptation
Syndrome model in 1936 showing in three phases what the alleged effects of stress has
on the body.
In his work, Selye - 'the father of stress research,' developed the theory that stress is a
major cause of disease because chronic stress causes long-term chemical
changes.
He observed that the body would respond to any external biological source of stress with
a predictable biological pattern in an attempt to restore the bodys internal homeostasis.
This initial hormonal reaction is your fight or flight stress response - and its purpose is
for handling stress very quickly! The process of the bodys struggle to maintain balance
is what Selye termed, the General Adaptation Syndrome.
Pressures, tensions, and other stressors can greatly influence your normal metabolism.
Selye determined that there is a limited supply of adaptive energy to deal with
stress. That amount declines with continuous exposure.

Every stress leaves an indelible scar, and the organism pays for its survival
after a stressful situation by becoming a little older.
~ Hans Selye

Going through a series of steps, your body consistently works to regain stability. With
the general adaptation syndrome, a humans adaptive response to stress has three
distinct phases:

ALARM STAGE Your first reaction to stress recognizes theres a danger and prepares to deal with the
threat, a.k.a. the fight or flight response. Activation of the HPA axis, the nervous system
(SNS) and the adrenal glands take place.
During this phase the main stress hormones cortisol, adrenaline, and noradrenaline, is
released to provide instant energy.
If this energy is repeatedly not used by physical activity, it can become
harmful.
Too much adrenaline results in a surge of blood pressure that can damage blood vessels
of the heart and brain a risk factor in heart attack and stroke.
The excess production of the cortisol hormone can cause damage to cells and muscle
tissues. Stress related disorders and disease from cortisol include cardiovascular
conditions, stroke, gastric ulcers, and high blood sugar levels.
At this stage everything is working as it should you have a stressful event, your body
alarms you with a sudden jolt of hormonal changes, and you are now immediately
equipped with enough energy to handle it.

RESISTANCE STAGE The body shifts into this second phase with the source of stress being possibly resolved.
Homeostasis begins restoring balance and a period of recovery for repair and renewal
takes place.
Stress hormone levels may return to normal but you may have reduced defenses
and adaptive energy left.
If a stressful condition persists, your body adapts by a continued effort in resistance and
remains in a state of arousal.
Problems begin to manifest when you find yourself repeating this process too often with
little or no recovery. Ultimately this moves you into the final stage.

EXHAUSTION STAGE At this phase, the stress has continued for some time. Your bodys ability to resist is lost
because its adaptation energy supply is gone. Often referred to as overload, burnout,
adrenal fatigue, maladaptation or dysfunction Here is where stress levels go up
and stay up!
The adaptation process is over and not surprisingly; this stage of the general
adaptation syndrome is the most hazardous to your health.
Chronic stress can damage nerve cells in tissues and organs. Particularly vulnerable is
the hippocampus section of the brain. Thinking and memory are likely to become
impaired, with tendency toward anxiety and depression.

There can also be adverse function of the autonomic nervous system that contributes to
high blood pressure, heart disease, rheumatoid arthritis, and other stress related illness.

The progressive stages of the general adaptation syndrome clearly show where having
excessive stress can lead. Given a choice, why would anyone purposely choose this
path? You may want to check out somerelaxation techniques or perhaps an herbal stress
relief strategy to help bring this under control.
The sources of stress are numerous with our hectic lifestyles, but luckily there are just as
many ways to relieve stress and still keep up and keep going.

Emotional Effects of Stress

You are most likely to feel the effects of stress when struggling with demands
that exceed your natural ability to cope.
How you perceive those challenges largely depend on the formed attitudes youve
acquired in life. Past conflicts may have established a stronghold of habitual negative
thoughts and reactions.
Recognizing the fight or flight stress response is key in fighting the effects of stress and
gaining back control.

What is stress and how does it affect mental health?

One definition of stress is:
-- a physical or emotional element that causes bodily or mental tension and may be a
factor in disease causation.
Did you get that?
We dont usually view our emotions as being the reason for getting sick. Negativity
carries so many harmful emotions such as anger, frustration and worry. This inner
turmoil quickly drains the mind and body of its available energy. As a result of being
increasingly on edge you also grow weary in thought and stamina.

God, grant me the serenity to accept the things I cannot change, the courage
to change the things I can, and the wisdom to know the difference.
~ Reinhold Niebuhr

Recharging your depleted energy reserves

Special attention should be placed on replenishing the energy levels that are being
exhausted. Emotional strain affects everyone differently.
There are distinct strategies in obtaining stress relief that will line up with your particular
need whether its for emotional tension, physical tension or both. Choose on the basis
of what feels right for you.
Cognitive functioning for clear thinking, problem solving and memory can also become
impaired. Look for fun ways to use and improve your thinking skills.
Without a remedy, the effects of stress leave you vulnerable for further decline particularly from the damage of prolonged chronic stress. These detrimental emotions
play havoc with your bodys chemistry.
For some, it can trigger emotional food cravings or nervous habits. The brain also signals
an over-abundant flow of stress hormones that contribute to serious physical effects and
ailments as well.
Many medical studies have been held and stress statistics are well documented.
As modern research on stress began during the 1930s, Hans Selye introduced
the general adaptation syndrome - his study on the biological reaction to stress.

"It's not stress that kills us, it is our reaction to it."

~ Hans Selye

Emotional stress that has become excessive or accumulative can

unfavorably tip the scales.

Burnout and midlife crisis are controversial emotional or psychological stress

related problems.

A stress disorder or perhaps panic attacks can develop from ongoing or frequent
bouts of stress.

Stress anxiety and depression result from feelings of losing control and carry
deep thoughts of overwhelm and hopelessness.

Post traumatic stress disorder is yet another serious stress related condition
usually suffered from experiencing a psychological trauma.
Needless to say, it is always wise to seek the medical advice of your doctor or other
qualified health professional when experiencing long aggravated stress symptoms.

Stress causes other common complications

Your bed can be viewed as a battleground when combating stress and insomnia. Many
worries at bedtime will prevent the relaxation needed for a good nights sleep. Sleep
deprivation only intensifies the adverse effects of stress.
If you are constantly getting angry and have a short fuse it could be in part, your
attitude! You may want to explore the reason why you are so quick-tempered. You can
learn to overcome this with good anger management skills. Look for relaxing ways to
quiet your agitations. Youll at least live your life happier, if not longer too.
Thankfully, we have an abundant range of emotions at our disposal. There are
tremendous health benefits mentally and physically for staying optimistic. So try to
become more aware of when you are being pessimistic in your views.

"Adversity is inevitable, but stress is optional"

~ Unknown

In conclusion, here's what to do

Want to remain in the best possible frame of mind?
Guard yourself from the emotional bad effects of stress. You cannot always control the
adversity that comes into your life, but you can choose how you are going to react to it.
Self-awareness is a good place to start.

Evaluate what your causes of stress are

Start managing stress appropriately

Get some good stress relievers working for you!

The intricate working of your mind emotion, mood, and behavior all interwoven
together is very complex.
Please realize that your overall wellness is affected and regulated in many powerful ways
from the emotional effects of stress. And it all closely ties in with the physiological
changes of the fight or flight response.

Physical Effects Of Stress

Having control over the ravaging physical effects of stress is a valid concern if
you suffer from significant amounts of tension in your life.
Its been estimated that nearly 80-90% of our visits to the doctor are due to stress
related illness or conditions. Staggering is the fact that most sickness and disease can be

traced to a root cause of emotional distress.

What goes on in your physical body is greatly influenced by the powerful mind-body
connection. You can literally worry yourself into an early grave. The actual physical
effects of stress on health can be extremely damaging. It is of the utmost importance
that you help your body function the way it was meant to.

Learn to relax. Your body is precious, as it houses your mind and spirit. Inner
peace begins with a relaxed body
~Norman Vincent Peale

How does stress affect health?

Your brain seeks to chemically regulate that elusive balance between stimulating and
tranquilizing your body. Adjustments are made whenever something disturbs the
metabolic equilibrium known as homeostasis.
When a threat arises the sympathetic nervous system (SNS) launches thefight-orflight response. This prepares you for quick action by speeding the heart rate,
constricting blood vessels, decreasing digestive activity, and raising blood pressure.
Contrary to that, the parasympathetic nervous system (PNS) ushers in the relaxation
response that calms everything back down.
Trouble starts when the SNS stress hormones stubbornly dominate with increased
activity that isnt easily suppressed or turned off. In time, this unnatural release of
the cortisol hormone and adrenaline floods your system to produce a slew of healthrelated problems.

Early signs of stress

Complaints early on from the physical effects of stress may include a stress headache,
backache, neck or shoulder stiffness. These are common and often caused by muscle
tension and tightness. The unconscious habit of jaw clenching or teeth grinding (even
while you sleep) is a sometimes-overlooked sign that can also lead to serious dental
problems.
Ever notice that stress and acne seem to go hand in hand when youre anxious over
some big event? Other skin conditions such as psoriasis, rosacea and eczema can also be
aggravated when youre under pressure. And the often-asked question, "Can stress
cause hives?" - that appears to be connected as well.
Theres clearly a link between stress and hair loss too.

Don't let your mind bully your body into believing it must carry
the burden of its worries

~Astrid Alauda

Frequently your appetite is affected by stress and weight loss occurs. On the other hand,
you might find yourself craving so-called comfort foods and overeating. Feeding your
body the proper amount of food and nutrients start with self-awareness. Try keeping
track of what triggers cause your eating habits by writing it down.
Stress and weight gain can grossly contribute to obesity and complicate health problems.
A high incident of body fat, specifically stubborn belly fat is associated with the hormone
cortisol and metabolic syndrome.
The physical effects of stress weakens your immune system. You are much more
vulnerable to colds and other infections. Thus, your ability to fight impending disease is
greatly diminished and compromised.

Physiological Effects of Stress and Premature Aging

Stress effects the body by speeding up the normal occurrence of oxidation. Free radicals
run rampant creating excessive wear and tear on internal organs and systems
throughout your body. When your distressed the very DNA within your cells is under
attack!
Weakened and abnormal cells divide and multiply an invitation for cancer!
Allergies, asthma and autoimmune diseases may become increasingly severe. With high
and prolonged levels of stress, health helplessly suffers in some way as bodily functions
are altered and begin to fail.
This accelerates the aging process, and brings on age-related disease!

Physical symptoms of stress and illness:

Adrenal fatigue symptoms - occur when over-stimulated adrenal glands have

reached exhaustion and no longer function properly

Brain cell damage or death in the hippocampus - the area of your brain needed
for memory, concentration and learning.

Chronic pain migraine, inflammation, arthritis

Diabetes - fluctuating blood-sugar levels and insulin-dependent diabetes in those

who may be predisposed to the disease.

Gastrointestinal problems heartburn, acid reflux, upset stomach, nausea,

ulcers, cramps, constipation, diarrhea, irritable bowel syndrome

Heart disease (cardiovascular disease) angina (chest pain from stress), heart
attack, stroke

High blood pressure (hypertension) - which has been referred to as the silent
killer, is many times discovered only during routine blood pressure checks

High (LDL) cholesterol, triglycerides

Insomnia fatigue, poor sleep

Sexual dysfunction disorders, PMS, infertility

"Take care of your body. It's the only place you have to live"
~Jim Rohn

Neutralize the side effects of stress

You can greatly improve your health and help counteract the physical effects of stress by
taking control of your health with a holistic approach in medicine.

Learn to use stress reduction techniques. It may require some effort on your part
to initiate your relaxation response, but take this seriously. Your health is the most
precious commodity you own. It is worth it!

Take steps to adequately nourish your body and promote the replication of vibrant
and healthy new cells. It is crucialnot only, but especiallyduring stressful situations
to neutralize and protect each and every cell from the devastation of free radicals.

Exercise daily

Get adequate sleep each night

These are very fundamental ways in preserving vitality and keeping the physical effects
of stress at bay. If you truly want to avoid being one of the many health statistics on
stress then
Commit to the importance of maintaining good health "for life" literally.

http://medical-dictionary.thefreedictionary.com/general+adaptation+syndrome

General Adaptation Syndrome

Definition
General adaptation syndrome, or GAS, is a term used to describe the body's shor
t-term and long-term reactions tostress.
Stressors in humans include such physical stressors as starvation, being hit by
a car, or suffering through severeweather. Additionally, humans can suffer such e
motional or mental stressors as the loss of a loved one, the inability tosolve a pro
blem, or even having a difficult day at work.
Description
Originally described by Hans Selye (19071982), an Austrian-born physician who
emigrated to Canada in 1939, thegeneral adaptation syndrome represents a thre

e-stage reaction to stress. Selye explained his choice of terminology asfollows: "I
call this syndrome general because it is produced only by agents which have a g
eneral effect upon largeportions of the body. I call it adaptive because it stimulat
es defense. I call it a syndrome because its individualmanifestations are coordi
nated and even partly dependent upon each other."
Selye thought that the general adaptation syndrome involved two major systems
of the body, the nervous system and theendocrine (or hormonal) system. He the
n went on to outline what he considered as three distinctive stages in thesyndro
me's evolution. He called these stages the alarm reaction (AR), the stage of resis
tance (SR), and the stage ofexhaustion (SE).
Stage 1: alarm reaction (ar)
The first stage of the general adaptation stage, the alarm reaction, is the immedi
ate reaction to a stressor. In the initialphase of stress, humans exhibit a "fight or
flight" response, which prepares the body for physical activity. However, thisinitia
l response can also decrease the effectiveness of the immune system, making pe
rsons more susceptible to illnessduring this phase.
Stage 2: stage of resistance (sr)
Stage 2 might also be named the stage of adaptation, instead of the stage of resi
stance. During this phase, if the stresscontinues, the body adapts to the stressor
s it is exposed to. Changes at many levels take place in order to reduce theeffect
of the stressor. For example, if the stressor is starvation (possibly due to anorexia
), the person might experienced areduced desire for physical activity to conserve
energy, and the absorption of nutrients from food might be maximized.
Stage 3: stage of exhaustion (se)
At this stage, the stress has continued for some time. The body's resistance to th
e stress may gradually be reduced, ormay collapse quickly. Generally, this means
the immune system, and the body's ability to resist disease, may be almosttotall
y eliminated. Patients who experience long-term stress may succumb to heart att
acks or severe infection due totheir reduced immunity. For example, a person wit
h a stressful job may experience long-term stress that might lead tohigh blood pr
essure and an eventual heart attack.
Stress, a useful reaction?
The reader should note that Dr. Selye did not regard stress as a purely negative p
henomenon; in fact, he frequentlypointed out that stress is not only an inevitable
part of life but results from intense joy or pleasure as well as fear oranxiety. "Str
ess is not even necessarily bad for you; it is also the spice of life, for any emotion
, any activity, causesstress." Some later researchers have coined the term "eustr
ess" or pleasant stress, to reflect the fact that such positiveexperiences as a job
promotion, completing a degree or training program, marriage, travel, and many
others are alsostressful.
Selye also pointed out that human perception of and response to stress is highly i
ndividualized; a job or sport that oneperson finds anxiety-provoking or exhaustin
g might be quite appealing and enjoyable to someone else. Looking at one'sresp

onses to specific stressors can contribute to better understanding of one's partic

ular physical, emotional, and mentalresources and limits.
Causes and symptoms
Stress is one cause of general adaptation syndrome. The results of unrelieved str
ess can manifest as fatigue, irritability,difficulty concentrating, and difficulty sle
eping. Persons may also experience other symptoms that are signs of stress.Pers
ons experiencing unusual symptoms, such as hair loss, without another medical
explanation might consider stressas the cause.
The general adaptation syndrome is also influenced by such universal human var
iables as overall health and nutritionalstatus, sex, age, ethnic or racial backgroun
d, level of education, socioeconomic status (SES), genetic makeup, etc.Some of t
hese variables are biologically based and difficult or impossible to change. For ex
ample, recent researchindicates that men and women respond somewhat differe
ntly to stress, with women being more likely to use what iscalled the "tend and b
efriend" response rather than the classical "fight or flight" pattern. These researc
hers note that mostof the early studies of the effects of stress on the body were c
onducted with only male subjects.
Selye's observation that people vary in their perceptions of stressors was reflecte
d in his belief that the stressorsthemselves are less dangerous to health than peo
ple's maladaptive responses to them. He categorized certain diseases,ranging fro
m cardiovascular disorders to inflammatory diseases and mental disorders as "di
seases of adaptation,"regarding them as "largely due to errors in our adaptaive r
esponse to stress" rather than the direct result of such outsidefactors as germs, t
oxic substances, etc.
Diagnosis
GAS by itself is not an official diagnostic category but rather a descriptive term.
A person who consults a doctor for astress-related physical illness may be sched
uled for blood or urine tests to measure the level of cortisol or other stressrelated hormones in their body, or imaging studies to evaluate possible abnormal
ities in their endocrine glands if thedoctor thinks that these tests may help to est
ablish or confirm a diagnosis.
The American Psychiatric Association (APA) recognizes stress as a factor in anxie
ty disorders, particularly post-traumatic stress disorder (PTSD) and acute
stress
disorder (ASD). These two disorders are defined as symptomaticreactions to ext
reme traumatic stressors (war, natural or transportation disasters, criminal assau
lt, abuse, hostagesituations, etc.) and differ chiefly in the time frame in which th
e symptoms develop. The APA also has a diagnosticcategory of adjustment
disorders, which are characterized either by excessive reactions to stressors wit
hin the normalrange of experience (e.g. academic examinations, relationship bre
akups, being fired from a job) or by significantimpairment in the person's occupat
ional or social functioning.

Treatment
Treatment of stress-related illnesses typically involves one or more stress
reduction strategies. Stress reductionstrategies generally fall into one of three c
ategories: avoiding stressors; changing one's reaction to the stressor(s); orrelievi
ng stress after the reaction to the stressor(s). Many mainstream as well as compl
ementary or alternative (CAM)strategies for stress reduction, such as exercising, l
istening to music, aromatherapy, and massage relieve stress afterit occurs.
Many psychotherapeutic approaches attempt to modify the patient's reactions to
stressors. These approaches ofteninclude an analysis of the patient's individual p
atterns of response to stress; for example, one commonly used set ofcategories
describes people as "speed freaks," "worry warts," "cliff walkers," "loners," "bask
et cases," and "drifters."Each pattern has a recommended set of skills that the p
atient is encouraged to work on; for example, worry warts areadvised to reframe
their anxieties and then identify their core values and goals in order to take concr
ete action about theirworries. In general, persons wishing to improve their mana
gement of stress should begin by consulting a medicalprofessional with whom th
ey feel comfortable to discuss which option, or combination of options, they can
use.
Selye himself recommended an approach to stress that he described as "living wi
sely in accordance with natural laws." Inhis now-classic book The Stress of Life (1
956), he discussed the following as important dimensions of living wisely:

Adopting an attitude of gratitude toward life rather than seeking revenge f

or injuries or slights.
Acting toward others from altruistic rather than self-centered motives.

Retaining a capacity for wonder and delight in the genuinely good and bea
utiful things in life.

Finding a purpose for one's life and expressing one's individuality in fulfillin
g that purpose.

Keeping a healthy sense of modesty about one's goals or achievements.

Resources
Books
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Dis
orders. 4th ed., revised. Washington,D.C.: American Psychiatric Association, 2000
.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Psychiatry in Medicine." Se
ction 15, Chapter 1 85 In The MerckManual of Diagnosis and Therapy. Whitehous
e Station, NJ: Merck Research Laboratories, 2004.

Periodicals
Benton, Tami D., MD, and Jacqueline Lynch, MSW. "Adjustment Disorders." eMedi
cine September 3, 2004.http://emedicine.com/med/topic3348.htm.
Cosen-Binker, L. I., M. G. Binker, G. Negri, and O. Tiscornia. "Influence of Stress in
Acute Pancreatitis and Correlationwith Stress-Induced Gastric Ulcer." Pancreatolo
gy 4 (July 2004): 470-484.
Motzer, S. A., and V. Hertig. "Stress, Stress Response, and Health." Nursing Clinic
s of North America 39 (March 2004):1-17.
Yates, William R., MD. "Anxiety Disorders." eMedicine August 15, 2004. http://e
medicine.com/med/topic152.htm.
Organizations
American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703 (914) 9631200. Fax: (914) 965-6267.http://www.stress.org.
American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888
) 357-7924. http://www.psych.org.
Canadian Institute of Stress/Hans Selye Foundation. Medcan Clinic Office, Suite 1
500, 150 York Street, Toronto, Ontario,Canada M5H 3S5. (416) 236-4218. http://
www.stresscanada.org.
National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 818
4, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. http://www.nimh.nih
.gov.
Other
"Stress management, General adaptation syndrome, GAS " http://www.holist
iconline.com/stress/stress_GAS.htm.
Key terms
Adjustment
disorder A disorder defined by the development of significant emotional or be
havioral symptoms inresponse to a stressful event or series of events within the
normal range of human experience.
Cortisol A steroid hormone released by the cortex (outer portion) of the adren
al gland when a person is under stress.
Eustress A term that is sometimes used to refer to positive stress.
Stress
management A set of techniques and programs intended to help people deal
more effectively with stress intheir lives by analyzing the specific stressors and t
aking positive actions to minimize their effects. Most stressmanagement progra
ms deal with job stress and workplace issues.

Stressor A stimulus or event that provokes a stress response in an organism.

Stressors can be categorized as acuteor chronic, and as external or internal to th
e organism.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights
reserved.

general adaptation syndrome

all nonspecific systemic reactions of the body to prolonged systemic stress, inclu
ding the ALARM REACTION, resistance, andexhaustion.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health,
Seventh Edition. 2003 by Saunders, an imprint of Elsevier, Inc. All rights
reserved.

general adaptation syndrome

a syndrome introduced by Hans Selye to describe a single marked physiologic re
sponse in the pituitary-adrenalsystem, as a result of exposure to a variety of prol
onged physical or psychological stresses or stressors, with thebodily changes pro
gressing through three stages that the author described as the alarm reaction, re
sistance, andfinally exhaustion. See: stress (4), stress (5). Compare: psychoen
docrinology.
Synonym(s): adaptation syndrome of Selye
Farlex Partner Medical Dictionary Farlex 2012

general adaptation syndrome (GAS)

Etymology: L, genus, kind; L, adaptare, to fit; Gk, syn, together, dromos, course
the defense response of the body or the psyche to injury or prolonged stress, as
described by Hans Selye (1907-1982). Itconsists of an initial stage of shock or ala
rm reaction, followed by a phase of increasing resistance or adaptation in whicht
he various defense mechanisms of the body or mind are used, and culminates in
a state of adjustment and healing or ofexhaustion and disintegration. Also called
adaptation syndrome. See also alarm reaction, crisis, posttraumatic
stress disorder, stress.
Mosby's Medical Dictionary, 9th edition. 2009, Elsevier.

general adaptation syndrome

A nonspecific term for a suboptimal short- or long-term physiologicresponse to p
hysical stimuli (e.g., trauma, hypothermia, starvation, infections, cardiovascular
events) or emotional stressors(e.g., bereavement, divorce, loss of job, etc.). The
original author of the GAS, Hans Selye, divided it into three stages:
(1) Alarm reactionthe fight or flight response;
(2) Stage of resistance or adaptationphysiologic responses to the stressors (e.g
., reduced activity to conserve energy);

(3) Exhaustion stage or burn out, in which the immune systems lose all defensive
capabilities, accompanied by multi-systemshutdown.
Management
Reduce stress.
Segen's Medical Dictionary. 2012 Farlex, Inc. All rights reserved.

general adaptation syndrome

(jen'r-l ad'ap-t'shn sin'drm)
A term introduced by Hans Selye to describe marked physiologic changes in vari
ous organ systems of the body,especially the pituitary-endocrine system, as a re
sult of exposure to prolonged physical or psychological stress.
Medical Dictionary for the Health Professions and Nursing Farlex 2012

general adaptation syndrome

(jen'r-l ad'ap-t'shn sin'drm)
Syndrome with single marked physiologic response in the pituitary-adrenal syste
m, due to exposure to a variety ofprolonged physical or psychological stressors.
Synonym(s): adaptation syndrome of Selye.
Medical Dictionary for the Dental Professions Farlex 2012

general adaptation syndrome

the syndrome described in humans as a consequence of continued stress. There i
s no identified counterpart inanimals.

www.integrativepro.com/Resources/Integrative-Blog/2014/General-AdaptationSyndrome-Stages
GENERAL ADAPTATION SYNDROME (GAS) STAGES

4/10/2014 10:44:05 AM // Holly Lucille, ND RN

SHARE
Hans Selye, MD, PhD (1907 - 1982), the Father of Stress, was a Hungarian endocrinologist and the first to give a
scientific explanation for biological stress. He actually borrowed the term stress from physics to describe an
organisms physiological response to perceived stressful events in the environment.

Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a
little older. - Hans Selye, MD, PhD

He eloquently explained his stress model, based on physiology and psychobiology, as the General Adaptation
Syndrome (GAS), stating that an event that threatens an organisms well being, a stressor, leads to a three-stage
bodily response:

Stages of GAS
1: Alarm
Upon perceiving a stressor, the body reacts with a fight-or-flight response and the sympathetic nervous system is
stimulated as the bodys resources are mobilized to meet the threat or danger.
2: Resistance
The body resists and compensates as the parasympathetic nervous system attempts to return many physiological
functions to normal levels while body focuses resources against the stressor and remains on alert.
3: Exhaustion
If the stressor or stressors continue beyond the bodys capacity, the resources become exhausted and the body is
susceptible to disease and death.

Evolving the Definition of Stress

As I enter my 14th year of practice I am convinced that the traditional of definition of stress, simply geared towards a
physical event or a mental state requiring the body to respond just doesnt cut it anymore. We live in a society where
there are stressful influences coming at us from all different directions. These stressors are multiple and confounded.
Making the issue worse, is the way I see patients choosing to respond to their perception of stress. The increase use of
alcohol, drugs, cigarettes, sugar and energy drinks in response to dealing with everyday stressors is creating an even
more stressful situation in the body. Whether the stress, perceived as good or bad, or it is passive or active, the
response by our bodies is intended to preserve life; it is a survival mechanism.

The Human Stress Response

The human stress response involves many components, as Selyes work portrayed. First, the brain initiates the most
immediate response signaling the adrenal glands to release epinephrine and norepinephrine. Then, the hypothalamus

and pituitary activate another part of the adrenals, releasing cortisol. This is followed by the nervous system initiating
behavioral responses like alertness, focus, reduction of pain receptors and the inhibition of reproductive behaviors and
desires. The sympathetic nervous system then kicks in to increase the heart rate, blood pressure and release fuel to
help fight or get out of danger as it redirects blood flow to the heart, muscles and brain, away from the gastrointestinal
tract and digestive processes. To accommodate these demands there is a vast increase in energy production and
utilization of nutrients and fluids in the body. Once the stressful situation has passed, the brain signals the responses to
be turned off and finally recovery and relaxation allow the body to re-establish balance in all systems, replacing lost
nutrients and eliminating waste products accumulated during the process.

The Missing Response Stage

The key element in this stress response that is missing in our modern day stress paradigm is RECOVERY. While there
are usually recovery times for life threatening events like getting chased by a polar bear, there are few for the
recurring events like backed up traffic, relationship troubles, financial pressures, job stresses, negative self-talk and
image, poor physical conditioning, artificial lighting, malnourished diet, inadequate sleep, genetically modified foods,
environmental toxin accumulation and so on.

In fact, these types of stressors each day can string themselves together rendering the stress response to be turned
on all of the time. In 2007, the American Psychological Association (APA) commissioned its annual nationwide survey
to examine the state of stress across the country. The key findings were noted as Portrait of a National Pressure
Cooker with almost 80% of the people surveyed reporting experiences of physical symptoms due to stress. I believe
that modern day stress is the up stream culprit of many of the down stream chief complaints I see every day in my
practice.

As practitioners, I believe we have to have a healthy respect for the great work of people like Dr. Selye and his General
Adaptation Syndrome (GAS) and treat what we know as clinical influencers in our modern day. Perhaps GAS could
also stand for Guidelines Against Stress and could help our patients maintain healthy stress levels and responses by
encouraging and educating each patient to identify and decrease unrelenting stressors. Also, we can help by repleating stress-induced nutrient depletions including vitamin C, pantothenic acid, calcium, and magnesium as well as
supporting healthy detoxification pathways and adrenal function. Herbal adaptogen options such as Rhodiola rosea
and Holy basil. further support the stress response.

Holly Lucille, ND RN
Dr. Holly believes in the science, art and mystery of healing and has a heartfelt passion for the individual wellness of all
people. Built on this foundational belief, Dr. Hollys private practice in Los Angeles, Healing from Within Healthcare,

focuses on comprehensive naturopathic medicine and individualized care. Outside of her practice, Dr. Holly holds a
position on the American Association of Naturopathic Physicians board of directors and she is also on the faculty of the
Global Medicine Education Foundation.

drholly.com
1. Devorah E. Klein, Gretchen Wustrack, Amy Schwartz

Medication Adherence: Many Conditions, A Common Problem; 2006

http://www.ideo.com/images/uploads/news/pdfs/HFES_IDEO-adherence_2006.pdf Accessed: August 19, 2013

http://www.holistic-online.com/stress/stress_GAS.htm

Our Bodys Reaction to Stress (General Adaptation Syndrome (GAS))

When a person experiences stress, the brain responds by initiating 1400 different responses
including the dumping of a variety of chemicals to our blood stream. This gives a momentary boost
to do whatever needs to be done to survive. If left unchecked, however, the person can have a
heart attack or stroke. Many people start drinking alcohol. They get depressed, find it difficult to
sleep, experience chest pain. The body runs out of the immunity to fight diseases. So, very often,
these persons die of disease such as cancer, pneumonia, etc. The stress will never be identified as
the cause of the death. I call the stress the proxy killer. Some other disease always takes the blame
for it.
Doctors call the bodys reaction to stress as General Adaptation Syndrome (GAS). There are three
stages to GAS.
In the first stage of GAS called alarm reaction, the body releases adrenaline and a variety of other
psychological mechanisms to combat the stress and to stay in control. This is called fight or flight
response. The muscles tense, the heart beats faster, the breathing and perspiration increases, the
eyes dilate, the stomach may clench. Believe it or not, this is done by nature to protect you in case
something bad happens. Once the cause of the stress is removed, the body will go back to normal.
If the cause for the stress is not removed, GAS goes to its second stage called resistance or
adaptation. This is the bodys response to long term protection. It secretes further hormones that
increase blood sugar levels to sustain energy and raise blood pressure. The adrenal cortex (outer
covering) produces hormones called corticosteroids for this resistance reaction. Overuse by the
body's defense mechanism in this phase eventually leads to disease. If this adaptation phase
continues for a prolonged period of time without periods of relaxation and rest to counterbalance
the stress response, sufferers become prone to fatigue, concentration lapses, irritability and
lethargy as the effort to sustain arousal slides into negative stress.
The third stage of GAS is called exhaustion. In this stage, the body has run out of its reserve of
body energy and immunity. Mental, physical and emotional resources suffer heavily. The body
experiences "adrenal exhaustion". The blood sugar levels decrease as the adrenals become
depleted, leading to decreased stress tolerance, progressive mental and physical exhaustion, illness
and collapse.
The hypothalamus-pituitary-adrenal (HPA) chain of command has served humans well as a means of
survival for thousands of years. However, for those suffering from chronic anxiety and depression
this process malfunctions. Continual stress early in life disrupts the cycle. Instead of shutting off
once the crisis is over, the process continues, with the hypothalamus continuing to signal the
adrenals to produce cortisol. This increased cortisol production exhausts the stress mechanism,
leading to fatigue and depression. Cortisol also interferes with serotonin activity, furthering the
depressive effect.

Continually high cortisol levels lead to suppression of the immune system through increased
production of interleukin-6, an immune-system messenger. This coincides with research findings
indicating that stress and depression have a negative effect on the immune system. Reduced
immunity makes the body more susceptible to everything from cold and flu to cancer. For example,
the incidence of serious illness, including cancer, is significantly higher among people who have
suffered the death of a spouse in the previous year. Fortunately, this immune-suppression process
can be corrected with psychotherapy, medication, or any number of other positive influences that
restore hope and a feeling of self-esteem. The ability of human beings to recover from adversity is
remarkable.
Thus, very often, those under severe, prolonged stress may contract diseases related to immune
deficiency and may even die of these diseases. The death does not come from stress itself. What
happens is that the body loses all its resistance in its effort to ward off the stress. Thus the persons
die of immune deficiency causes such as infection, cancer etc. So, it is very important that we
recognize the cause for stresses and remove the causes to maintain a healthy lifestyle.
Another result of stress is the clogging of the arteries by the fat and cholesterol released by the
body during the attempt to fight stress. This may result in a heart attack or you may suffer a stroke
by losing blood supply to the brain. Many people start drinking to combat the stress. Stress can also
manifest itself into a number of diseases depression, headaches, insomnia, ulcers, asthma, and
more.