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Stress in the 21Stress in the 21stst Century Century

Dr. Harold LevineDr. Harold Levine

Chief Medical OfficerChief Medical Officer

May 2009May 2009

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Another type of Stressor: Another type of Stressor: Ambiguous Loss (Pauline Boss)Ambiguous Loss (Pauline Boss)

Physical Absence – Psychological PresencePhysical Absence – Psychological Presence Children who leave for collegeChildren who leave for college MIA/POW soldiersMIA/POW soldiers TerrorismTerrorism Natural disastersNatural disasters Kidnapped/missing childrenKidnapped/missing children

Physical Presence – Psychological AbsencePhysical Presence – Psychological Absence Family member with Alzheimer’s DiseaseFamily member with Alzheimer’s Disease Aging parentsAging parents AutismAutism AddictionAddiction DepressionDepression

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Physical Symptoms of Physical Symptoms of StressStress

muscle tension muscle tension racing pulse racing pulse shallow, fast breathing shallow, fast breathing trembling trembling dry mouth dry mouth cold or sweaty hands cold or sweaty hands nervous tics nervous tics jaw grinding jaw grinding upset stomach upset stomach headache headache exhaustion exhaustion long-term health problems such as ulcers or cardiovascular long-term health problems such as ulcers or cardiovascular

complaints complaints

Stress – it’s Personal. AchieveSolutions. L. Stewart 2003.

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How Does the Body How Does the Body Respond to Stress?Respond to Stress?

Brain releases hormones (adrenalin & cortisol).Brain releases hormones (adrenalin & cortisol). Less able to produce & maintain white blood cells Less able to produce & maintain white blood cells

to fight infection. We become more susceptible to fight infection. We become more susceptible to infection & disease.to infection & disease.

Lining in arteries constricts (raising blood Lining in arteries constricts (raising blood pressure and causing cardiovascular problems).pressure and causing cardiovascular problems).

Women with high stress are more likely to die Women with high stress are more likely to die from stroke or heart disease than those with low from stroke or heart disease than those with low stress levels.stress levels.

Men with moderate-high stress are nearly twice Men with moderate-high stress are nearly twice as likely to have heart attack.as likely to have heart attack.

70-80% of all doctor visits are for illnesses that 70-80% of all doctor visits are for illnesses that are stress-related or stress-induced.are stress-related or stress-induced.

The Brain-body Connection: Depression, Anxiety, Stress and Physical Health. D. Edwards, 2008, AchieveSolutions.

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Behavioral SymptomsBehavioral Symptoms

fidgeting fidgeting accident-prone accident-prone stuttering stuttering sleep changes—insomnia or sleeping too sleep changes—insomnia or sleeping too

much much decreased or increased appetite decreased or increased appetite increased use of alcohol or other drug increased use of alcohol or other drug crying for no reason crying for no reason impulsiveness impulsiveness any change that causes you concern any change that causes you concern

Stress – it’s Personal.

Stress – It’s Personal. L. Stewart 2003. AchieveSolutions

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Emotional SymptomsEmotional Symptoms

persistent negative thoughts persistent negative thoughts difficulty relaxing difficulty relaxing irritability and moodiness irritability and moodiness trouble concentrating trouble concentrating anger anger anxiety anxiety depression depression

Stress – It’s Personal. L. Stewart 2003 AchieveSolutions

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AnxietyAnxiety

Symptoms can include but are not limited to:Symptoms can include but are not limited to: Excessive worryExcessive worry Feeling fatiguedFeeling fatigued IrritabilityIrritability Difficulty concentratingDifficulty concentrating TensionTension Panic AttacksPanic Attacks

Pounding heart or increased heart ratePounding heart or increased heart rate Feels like chokingFeels like choking Chest painChest pain SweatingSweating TremblingTrembling Sensations of shortness of breath or smotheringSensations of shortness of breath or smothering Fear of losing controlFear of losing control Fear of dyingFear of dying

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DepressionDepression

Symptoms can include but are not limited to:Symptoms can include but are not limited to: Depressed moodDepressed mood Diminished interest in activitiesDiminished interest in activities Weight loss/weight gainWeight loss/weight gain Insomnia or sleeping more than usualInsomnia or sleeping more than usual Loss of energyLoss of energy Feeling worthlessFeeling worthless Decreased ability to think or concentrateDecreased ability to think or concentrate Thoughts of death, suicideThoughts of death, suicide

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Depression, Heart Disease & Depression, Heart Disease & DiabetesDiabetes

Depressed people are about 60% Depressed people are about 60% more likely to develop type 2 more likely to develop type 2 diabetes when compared to those diabetes when compared to those who are not depressed.who are not depressed.

Depressed women are more likely to Depressed women are more likely to have heart disease than those who have heart disease than those who are not depressed.are not depressed.

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Anxiety & Physical Anxiety & Physical ConditionsConditions

People with anxiety disorders are at People with anxiety disorders are at an increased risk for:an increased risk for: Thyroid diseaseThyroid disease Respiratory diseasesRespiratory diseases Gastrointestinal diseasesGastrointestinal diseases ArthritisArthritis AllergiesAllergies MigrainesMigraines

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Steps You Can TakeSteps You Can Take

Take several slow, deep breaths. Take several slow, deep breaths. Relax any tight muscles you notice. Relax any tight muscles you notice. Go for a brisk walk. Go for a brisk walk. Exercise regularly.Exercise regularly. Read, listen to soothing music or work on a hobby. Read, listen to soothing music or work on a hobby. Meditate, pray or write in a journal. Meditate, pray or write in a journal. Get enough sleep.Get enough sleep. Maintain a healthy diet.Maintain a healthy diet. Talk to a counselor or doctor if your symptoms Talk to a counselor or doctor if your symptoms

persist over several weeks. persist over several weeks. Stress – It’s Personal. L. Stewart 2003 AchieveSolutions; The Brain-body Connection: Depression, Anxiety, Stress and Physical Health. D. Edwards 2008 AchieveSolutions

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Getting Professional HelpGetting Professional Help

Grounding techniquesGrounding techniques Progressive relaxationProgressive relaxation HypnosisHypnosis Cognitive Behavioral Therapy Cognitive Behavioral Therapy

(restructure thoughts)(restructure thoughts) Community Support GroupsCommunity Support Groups MedicationMedication

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How to Help Your Children with How to Help Your Children with DepressionDepression

Watch for symptoms like these & more:Watch for symptoms like these & more: Persistent sadness & hopelessnessPersistent sadness & hopelessness Withdrawal from friends & activitiesWithdrawal from friends & activities Missed schoolMissed school ForgetfulnessForgetfulness Poor self-esteemPoor self-esteem Frequent physical complaints like stomachachesFrequent physical complaints like stomachaches Drug & alcohol abuseDrug & alcohol abuse Suicidal thoughts or thoughts about deathSuicidal thoughts or thoughts about death

Early Onset Depression information from NAMI

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If you notice these signs of If you notice these signs of depression in your child, depression in your child,

steps to take:steps to take: Get professional help (counselor and/or Get professional help (counselor and/or

doctor)doctor) Get accurate information from libraries, Get accurate information from libraries,

helplines & other sources (like helplines & other sources (like AchieveSolutions)AchieveSolutions)

Ask questions about treatment & servicesAsk questions about treatment & services Talk with other families with similar Talk with other families with similar

problemsproblems Find a support group such as NAMIFind a support group such as NAMIEarly Onset Depression information from NAMI

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JessieJessie

Jessie is a 15 year old girl. She’s had Jessie is a 15 year old girl. She’s had her first break up with a boyfriend. her first break up with a boyfriend. Her parents are worried that she’s Her parents are worried that she’s having trouble getting over him and having trouble getting over him and appears depressed. They wonder if appears depressed. They wonder if she should be placed on she should be placed on antidepressants.antidepressants.

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JoeJoe

Joe is 39 and was informed there will Joe is 39 and was informed there will be layoffs at the factory where he’s be layoffs at the factory where he’s been employed since high school. He’s been employed since high school. He’s feeling worthless, drinking a 12 pack feeling worthless, drinking a 12 pack every night, and having thoughts that every night, and having thoughts that his family would be better off if he was his family would be better off if he was dead. He says he won’t commit suicide dead. He says he won’t commit suicide now, but he can’t stop thinking about now, but he can’t stop thinking about it.it.

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JackieJackie

Jackie is a 48 year old female who Jackie is a 48 year old female who lost her house and her dog in a lost her house and her dog in a recent flood. She cries often and recent flood. She cries often and can’t think straight. She feels can’t think straight. She feels panicked. She has nightmares that panicked. She has nightmares that she’s in her house and it’s flooding she’s in her house and it’s flooding again. She’s not getting much sleep.again. She’s not getting much sleep.

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SarahSarah

Sarah is 13. She was excited to get Sarah is 13. She was excited to get on Twitter. She spends a lot of time on Twitter. She spends a lot of time in her bedroom with her door closed, in her bedroom with her door closed, Tweeting. Her parents overheard her Tweeting. Her parents overheard her talking about a boy she allowed to talking about a boy she allowed to “follow her.” She’s been Tweeting “follow her.” She’s been Tweeting him about meeting at the mall.him about meeting at the mall.

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BobBob

Bob is 53 years old. He and his wife Bob is 53 years old. He and his wife are losing their home due to are losing their home due to foreclosure. Bob is distraught about foreclosure. Bob is distraught about their financial situation, can’t figure out their financial situation, can’t figure out how to make the situation better and how to make the situation better and has constant thoughts about killing has constant thoughts about killing himself. He plans to overdose on himself. He plans to overdose on medications he has or shoot himself medications he has or shoot himself with his hunting rifle.with his hunting rifle.

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Questions?Questions?

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References & ResourcesReferences & Resources

www.ambiguousloss.comwww.ambiguousloss.com http://www.arizonasexualassaultnetwork.org/assaultinfo.htmlhttp://www.arizonasexualassaultnetwork.org/assaultinfo.html www.autismspeaks.orgwww.autismspeaks.org Boss, P. (2006) Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Boss, P. (2006) Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous

Loss. Loss. Diagnostic Statistical Manual (DSM IV TR)Diagnostic Statistical Manual (DSM IV TR) Edwards, D (2006). Domestic Violence Affects People of all Backgrounds. Edwards, D (2006). Domestic Violence Affects People of all Backgrounds.

AchieveSolutions.AchieveSolutions. Edwards, D. (2008) The Brain-body Connection: Depression, Anxiety, Stress and Edwards, D. (2008) The Brain-body Connection: Depression, Anxiety, Stress and

Physical Health. AchieveSolutions.Physical Health. AchieveSolutions. Edwards, D. (2001) Overcoming Stress in the Workplace. AchieveSolutions.Edwards, D. (2001) Overcoming Stress in the Workplace. AchieveSolutions. http://www.ftc.gov/bcp/edu/microsites/idtheft/http://www.ftc.gov/bcp/edu/microsites/idtheft/ Stewart, L. (2003) Stress – it’s Personal. AchieveSolutions. Stewart, L. (2003) Stress – it’s Personal. AchieveSolutions. Motor Vehicle Traffic Crashes As a Leading Cause of Death in the United States, Motor Vehicle Traffic Crashes As a Leading Cause of Death in the United States,

2005(April, 2008). National Highway Traffic Safety Administration.2005(April, 2008). National Highway Traffic Safety Administration. http://www.nami.org/Content/ContentGroups/Helpline1/Facts_About_Childhhttp://www.nami.org/Content/ContentGroups/Helpline1/Facts_About_Childh

ood_Depression.htmood_Depression.htm http://onguardonline.gov/socialnetworking.htmlhttp://onguardonline.gov/socialnetworking.html www.staysafe.orgwww.staysafe.org