Updated 03 August 2018

What is stress and what causes it?

Adults and children have to deal with increasing stressors. We look at stress and its impact on people.

Exposure to stressful situations is one of the most common human experiences. These situations can range from daily annoyances and the consequences of overstretched, time-pressured lifestyles, to unexpected events such as illness, loss, natural disasters, and the dramatic effects caused by war-torn environments with ever-present uncertainty and armed conflict.

Stress can be defined as the inability to cope with a perceived threat (real or imagined) to one’s mental, physical, emotional and spiritual well-being, which results in a series of physiological responses and adaptations. Examples of stress include financial, marital, work- and health-related stress. We all have our ways of coping with change, so the causes of stress can be different for each person.

Stress can be either good or bad. Good stress positively compels people to action (e.g. to study for an exam, or a baby learning to crawl), whereas bad stress results in negative feelings such as distrust, anger and depression (e.g. the death of a loved one). Bad stress can be acute or chronic and may lead to serious health problems.

Stress is a subjective experience
Much of the stress we experience is based on our own perception of a situation; therefore, sources of stress can vary greatly from one person to another. What any individual perceives as a stressor is a stressor for that person, regardless of another’s evaluation of that situation. Whether one perceives a situation as a threat, either psychological or physical, is crucial in determining the behavioural response (whether it is fleeing, fighting, or cowering in fear) and the physiologic response (calmness or heart palpitations and elevated cortisol levels).

It is clear that stress has a significant effect on health. It can affect the onset of, or susceptibility to disease. Stress can also affect the progression or course of disease, even when there is another cause of the disease; and can affect one’s recovery from disease. Chronic stress has been linked to cancer, diabetes, obesity, and alcohol and substance abuse. In addition, developmental abnormalities and neuro-degeneration can occur due to an overload of stress. This is particularly relevant to children under chronic stress.

Two factors largely determine individual responses to stressful situations: the way the person perceives the situation, and the person’s general state of physical health. Symptoms of stress can be physical (fatigue, headache, nausea, indigestion, breathlessness, skin rashes, chest pains and cramps), mental (poor concentration, memory difficulties, confusion, demotivation and loss of sense of humour), emotional (anxiety, depression, fear, anger and irritability), and/or behavioural (unsociable, poor time management, increase in appetite, smoking, drinking, swearing, and yelling).

With continuous stress the body becomes more vulnerable to physical or psychological problems. Long-term effects of prolonged stress can include hypertension, headaches, arthritis, adrenal fatigue, decreased immune function, cancer, peptic ulcers, infertility, ageing and reduction of quality of life.

Has there been an increase in the number of people developing stress?
Stress, anxiety, worry, and aggression have all increased significantly in recent years. Individuals off all ages throughout the world, not just in South Africa, are reacting physically and mentally to constant stress, with the clinical manifestations of stress being seen in doctors' offices every day. As a result of these stressors, psychiatric diseases are now emerging as a highly significant component of global disease.

It would seem that no age group (from young to old) has been immune to the greater stressful demands that are now being perceived. For example, studies have shown that mothers who are stressed during pregnancy are more likely to give birth to low birth weight babies.

Why do people develop stress?
Society has changed greatly in the last few decades, most noticeable due to the technology explosion. Not only is just about any information available at your fingertips through the internet, but communication has become instant (e.g. cellphones, emails, instant messaging). Transport, too, has vastly improved and become more accessible, with some business people flying to another city for the day to do a quick presentation before returning home again. All of these factors have not only made our lives easier, but it has subsequently created greater pressures and constraints on us.

Expectations are greater, ambitions are higher and there is pressure to perform in all aspects of life. For example, it is now often expected of people to be accessible by cellphone 24 hours a day, whereas many years ago once a person had left the office they did not have to think of work again until the next day.

Additionally, in the past most people considered other people in the local community as role models, whereas now they hold themselves up against the inflated images of celebrities that are perpetuated by the media. Such expectations are often unrealistic and unattainable. Other issues like greater financial constraints due to increased cost of living also come into play (e.g. with most household requiring two incomes to ‘survive’).

Why are children feeling stressed?
The number of children with psychological and emotional problems has grown dramatically in recent years (e.g. psychosocial problems in children tripled between 1979 and 1996). Early experiences of stress are believed to affect the level of responsiveness of the autonomic nervous system. Therefore, young children exposed to chronic stress can become overly accustomed to dealing with fear states and become conditioned to having or tolerating higher levels of adrenaline. Consequently, as adults they may become “hot reactors”, easily triggering the fight or flight reaction. In extreme cases, chronic stress can even suppress the secretion of normal growth hormones in children, therefore stunting growth.

Pressures come from multiple sources; both external (such as family, friends, or school) and internal. The pressure we place on ourselves can be most significant because there is often a discrepancy between what we think we ought to be doing and what we are actually doing in our lives.

Stress can affect anyone, even a child, who feels overwhelmed. A 2-year-old child, for example, may be anxious because the person he or she needs to feel good (e.g. a parent) isn't there enough to satisfy him or her. In preschoolers, separation from parents is the greatest cause of anxiety. This is particularly relevant in our current society, where fewer parents are financially able to stay home with their children, and therefore need to send their children to crèches and day-cares from an early age.

Academic and social pressures
As children get older, stress often comes in the form of academic and social pressures (especially the desire to fit in). In addition, well-meaning parents sometimes unwittingly add to the stress in their children's lives by having great expectations for their children, who may lack their parents' motivation or capabilities. Parents who push their children to excel in sports or who enrol their children in too many activities may also cause unnecessary stress and frustration if their children don't share their goals.

Many professionals feel that a number of children are too busy and do not have time to play creatively or relax after school. Kids who begin to complain about the number of activities they are involved in or refuse to go to activities may be signalling to their parents that they are too busy. It's a good idea to talk with your child about how he or she is feeling about after-school activities. If he or she complains, talk about the pros and cons of quitting one of the activities. If quitting isn't an option, talk about ways that you can help your child manage his or her time and responsibilities so that they don't create so much anxiety.

Your child's stress level may be intensified by more than just what's happening in his or her own life. Parents need to be careful how they discuss issues (e.g. when talking about troubles at work, worrying about a relative's illness, or fighting with a spouse about financial matters) when their children are near because children will pick up on their parents' anxieties and start to worry themselves.

The same could be said for exposure to sensitive news events. Children who watch replays of the disturbing images on TV or hear talk of car crashes, civil unrest, and terrorism may worry about their own safety and that of the people they love. Talk to your child about what he or she sees and hears and monitor what he or she watches on TV so that you can help your child understand what's going on and reassure him or her.

Also, consider that complicating factors, such as an illness, death of a loved one, or a divorce, may be causing your child's stress. When these factors are added to the everyday pressures kids face, the stress is magnified. Even the most amicable divorce can be a difficult experience for children because their basic security system (i.e. their family) is undergoing a tough change. Separated or divorced parents should never put kids in a position of having to choose sides or expose them to negative comments about the other spouse.

It's not always easy to recognise when your child is stressed out. Short-term behavioural changes can be indicators of stress, such as mood swings, acting out, changes in sleep patterns, or bedwetting. Some children experience physical effects, including stomach-aches and headaches, while others have trouble concentrating or completing schoolwork. Still others become withdrawn or spend a lot of time alone.

Younger children may show signs of reacting to stress by picking up new habits like thumb sucking, hair twirling, or nose picking, while older children may begin to lie, bully, or defy authority. A child who is stressed out may also have nightmares, difficulty leaving you, overreactions to minor problems, and drastic changes in academic performance.

Are more people going onto anti-depressants and, if so, why?
With the increase of mass media and a gradual willingness for people to be more open about mental health issues, more people are willing to admit that they are not coping adequately with the stress around them. The use of anti-depressants has therefore become more visible due to [a] more people willing to admit that they are on anti-depressants (as it no longer holds the same social stigma that it was perceived to be a few decades ago), and [b] more people becoming aware of the availability of medication as an option for such difficult times (instead of struggling alone).

What can be done to manage stress?
Stress can be managed through maintaining a healthy body (e.g. through exercise, diet, sleep hygiene, avoiding stimulants and correct posture), healthy relationships (e.g. social interaction, making time for self and others, sharing feelings and communicating, be accepting, be assertive and learn to say no), and learning management skills (e.g. analysing, prioritising, delegating, time management). Relaxation techniques can also be used to manage the negative effects of stress. This could be in the form of meditating, praying, deep breathing, massage, reading, taking a warm bath or doing a hobby that you enjoy.

It’s important to become aware of your stressors and your emotional and physical reactions. Learn how to moderate your physical reactions to stress. Reduce the intensity of your emotional reactions to stress, e.g. by recognising what you can change and what is out of your control, and build physical and emotional reserves. These reserves can only be built by focusing on yourself and your own health.

Although some people may perceive this to be selfish, it is unreasonable to expect somebody to perform well and look out for other people when they cannot cope themselves. For example, how can a mother expect to be a good parent to her child when she is pushed and pulled to capacity (from all her different ‘duties’ that she feels compelled to)? It will rarely be disputed that a mother who is relaxed, calm and with good mental health is a more effective parent than somebody who feels tense, irritable and ready to fall apart yet.

People often need to achieve more balance in their lives. While it isn’t necessarily wrong to work hard, perhaps it is equally necessary to play/relax just as ‘hard’. Achieve a healthy balance between work, social, family and individual time.

Lisa Aitken, MRC Unit on Anxiety and Stress Disorders


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