Many people, over the course of their lives, have experienced acute stress, a dramatic physiological and psychological reaction to a specific event. Chronic stress, however, is a consistent sense of feeling pressured and overwhelmed over a long period of time.

“We humans are very good at facing a challenge, solving a situation, or reaching out to someone to get support,” says Rajita Sinha, PhD, director of Yale Medicine’s Interdisciplinary Stress Center. “We’re wired to respond to stress and remove it, sometimes even automatically. But life has become more complex, and many situations don’t have easy answers.”

Sinha founded the Yale Stress Center in 2007 to study stress from an interdisciplinary perspective and to improve the treatment of stress-related diseases.

Causes of chronic stress could include poverty, a dysfunctional marriage or family, or a deeply dissatisfying job. In today's hectic society, there are many possible sources. Chronic stress slowly drains a person’s psychological resources and damages their brains and bodies. “People experiencing chronic stress might feel incapable of changing their situations,” Sinha says.

There are cognitive, emotional, physical and behavioral signs of chronic stress. “Not all four of these categories of symptoms are necessarily going to show up in one person,” Sinha says. “But if someone has three to five of these symptoms for more than several weeks, they might be suffering from chronic stress.” Those potential symptoms include:

• Aches and pains
• Insomnia or sleepiness
• A change in social behavior, such as staying in often
• Low energy
• Unfocused or cloudy thinking
• Change in appetite
• Increased alcohol or drug use
• Change in emotional responses to others
• Emotional withdrawal

Ongoing stress reactions can interfere with productivity, relationships and health. “People suffering from chronic stress often describe it as feeling ‘stuck,’” Sinha says.

Chronic stress is linked to other conditions, both psychological and physical. These can include:

• Diseases such as hypertension, heart disease, obesity and metabolic syndrome, Type II diabetes, and arthritis
• Addiction to alcohol, nicotine and/or prescription drugs, and behavioral-related such as addiction to the internet, food, or gambling
• Mood disorders and anxiety disorders, which are common secondary diagnoses for people with chronic stress

Hypertension, depression, addiction and anxiety disorders are the conditions most related to chronic stress.

A mental health professional can interview a patient to gather information about the overall presence of stress. Given the wide range of symptoms and linked conditions, the diagnosis may require input from other specialists. "An integrative approach is best,” Sinha says. “I might pull in an endocrinologist to see a patient if I think a patient’s issues are related to metabolic problems, for instance.” Stress biology, such as stress hormones and other physiological changes related to stress, may also perpetuate a chronic stress state and related conditions, so assessing those factors is also important.

Patients with chronic stress often receive a treatment plan that targets their specific symptoms. A patient with digestive issues rooted in stress could go on medication, change his or her diet and also focus on stress reduction. As Sinha says, “It’s better to address these earlier, as a preventative approach.”

Yale Medicine’s stress management recommendations include:

• Exercising
• Eating healthy foods
• Learning time management techniques
• Setting realistic goals
• Getting more sleep
• Making time for leisure activities
• Building stress reduction skills
• Learning and practicing mindfulness (learning to control attention)

The Yale Stress Center conducts clinical trials that attempt to find biomarkers of stress that relate to chronic disease risk. Researchers at the center also develop and test new interventions to prevent and treat stress-related diseases. The Stress Center also holds classes and training workshops for the public on mindfulness and other stress-reduction techniques. 

“An interdisciplinary approach to stress is the wave of the future,” Sinha says. “We are working to understand the mechanisms behind all manifestations of stress, and also studying its effects in diseases that are the endpoints of chronic stress.”