By Kasmiah Mustapha

An adverse reaction to stress manifests itself in physical and psychological symptoms but this can be changed to get a better outlook on life, writes KASMIAH MUSTAPHA.

ANITA has always suffered from headaches and back pain, which she dismissed as a part of ageing. Then one day, it was so severe that she fainted in the office.

She was sent to the emergency room but after a thorough check-up, the doctor could not find anything physically wrong with her.

Her fainting spell continued for about a week. The doctor was perplexed as he had done a CT scan and an MRI, and didn't detect any tumour or abnormal changes in her body.

As any medical condition was ruled out, the doctor suspected she could be having emotional or psychological issues. He asked her questions about her personal life, family and work.

It turned out that she was in a highly demanding job that required her to be available to the bosses almost 24 hours a day. To make matters worse, two of the employees in her department had resigned recently.

With the additional workload and constantly worrying about meeting the bosses' demand, Anita's body started to react to the stressful situation. The headaches and pains then escalated to fainting spells.

Anita was advised to seek psychological help to address her situation and find ways to cope with it.

Prince Court Medical Centre clinical psychologist Hariyati Shahrima Abd Majid said stress is a psycho physiological concept in which the body reacts to a situation which a person perceives as threatening.

If he is unable to handle the situation well, it will cause physical and psychological symptoms.

"Excessive stress will bring about certain symptoms. The body will show symptoms that we've never experienced or we'd suffer from them more than usual.

"When we perceive something as a threatening stimulus, our brain will receive the information and release the stress hormone cortisol excessively. This will cause havoc in our body."

When the person cannot handle the situation which he perceives as stressful, he will get easily irritated, agitated, anxious, start overeating and find it difficult to fall asleep.

He could also suffer from migraines, heart palpitations, backaches and pains, arthritis and tremors as well as shaking.

Hariyati said, however, the severity of the threat is actually a perception. When the person perceives that he is unable to cope with the excessive demands placed upon him, his body will react to the situation.

"The perception is the disability to cope with the stimuli. When we don't think we have the resources than we will experience the impact of stress.

"We actually do not understand our body well enough because there are resources that we can mobilise to help cope with the situation."

Stress will have a negative impact if our reaction to it turns chronic. If a person continues to perceive the issue as a threat, in the long run it may cause him to develop symptoms detrimental to his health.

"If stress is not managed properly, it does increase health risks. When you cope with stress by smoking or eating unhealthily, there's the risk of getting heart disease, cancer or growing obese.

"It would be the combination of not being able to handle stress that leads to unhealthy living which then causes illnesses."

Many people think that stress always has a negative impact on their lives. But there is "good" stress which can improve performance and motivate one to do better.

Different people have different reactions to situations. Some people have a high level of tolerance, so even in the most difficult conditions, they will be calm. Some get agitated easily and this will cause drastic changes in the body.

"The impact will depend on how a person perceives or evaluates the stressors or threatening stimulus.

"For example, when you are stuck in a traffic jam and you perceive the situation as threatening, you will get irritated, angry and maybe even have problems breathing.

"But if you realise that you do not have control over the situation, you will find ways to deal with it. Maybe turn on the radio and sing along to the songs."

As stress is a psychological condition, its management is through lifestyle modification such as participating in physical activities, eating healthily and, most importantly, modifying one's reaction to the stressor.

One of the classic symptoms of stress is increased paranoia in which one starts to have catastrophic thoughts of all the worst things that could happen or things one could do to change the situation, said Hariyati.

"When the boss calls you into the office, your first thought would be that you are in trouble. You begin to feel anxious and think of the worst thing that can happen.

"These thoughts usually lead to unnecessary increased stress levels. We help patients modify these thoughts into something more constructive and adaptable to them."

Stress management is through lifestyle modification and behavioural changes. The first step is to identify the stressor and find ways to overcome it.

"We are not denying that medication is needed to treat the symptoms but there is a need to address the reason why we are stressed in the first place.

"The medication may be able to reduce the symptoms for a while but you will keep having them because you have not addressed the source of your stress.

"To overcome it, a multi-disciplinary approach is required, especially if you have a medical condition.

"If you are suffering from certain physical symptoms, you need to see a doctor who needs to assess and diagnose your condition.

"Doctors also have to realise that stress components can also play a role in either the onset or exacerbation of the illness."

Common symptoms of stress:

• A fast heartbeat and fast breathing.
• A headache, a stiff neck and/or tight shoulders and back pain.
• Sweating and sweaty palms.
• An upset stomach, nausea or diarrhoea.

You may:

• Feel cranky and unable to deal with even small problems.
  
• Feel frustrated, lose your temper more often and yell at others for no reason.
• Feel jumpy or tired all the time.
  
• Find it hard to focus on tasks.
  
• Worry too much about small things.
  
• Imagine that bad things are happening or about to happen.

In the long term, stress can affect your:

• Immune system.
  Constant stress can make you more likely to get sick more often. And if you have a chronic illness such as AIDS, stress can make your symptoms worse.
• Heart
  Stress is linked to high blood pressure, abnormal heartbeat (arrhythmia), blood clots, and hardening of the arteries (atherosclerosis). It's also linked to coronary artery disease, heart attack and heart failure.
• Muscles
  Constant tension from stress can lead to neck, shoulder and low back pain. Stress may make rheumatoid arthritis worse.
• Stomach
  If you have stomach problems, such as gastroesophageal reflux disease, peptic ulcer disease, irritable bowel syndrome, or ulcerative colitis, stress can make your symptoms worse.
• Reproductive organs
  Stress is linked to low fertility, erection problems, problems during pregnancy and painful menstrual periods.
• Lungs
  Stress can make symptoms of asthma and chronic obstructive pulmonary disease worse.
• Skin
  Skin problems such as acne and psoriasis are made worse by stress.

Ways to relieve stress

• Write
  It may help to write about things that are bothering you. Write for 10 to 15 minutes a day about stressful events and how they make you feel. Or think about starting a stress journal. This helps you find out what is causing your stress and how much stress you feel. After you know, you can find better ways to cope.
• Let your feelings out
  Talk, laugh, cry, and express anger when you need to. Talking with friends, family, a counsellor or a member of the clergy about your feelings is a healthy way to relieve stress.
• Do something you enjoy.