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Everyone experiences stress. Whether it is everyday hassles, such as being stuck in traffic, or more acute
forms of stress, such as pain or traumatic experiences, stress plays a part in everyone's lives. In this
paper I will discuss the various forms of stress, how stress affects the immune system, and how that
affectation influences diseases.
Before diving right into the technical aspects of stressors and the immune system, I need to define
several terms. A stressor is any stimuli that causes a nonspecific response in an indidual, otherwise
known as stress (Elliott and Eisdorfer, 1982).
There are two main catagories of stress: acute and chronic. Acute stressors include unpleasant films,
understimulation/work underload, overstimulation/work overload, unexpected or uncontrollable noise,
prestige or status loss, electric shock, uncontrollable situations, physical illness, surgery, threats to selfesteem, and traumatic experiences. Chronic stressors include sleep deprivation, daily "hassles", work
overload or underload, role strains, or social isolation. There are, of course, many more things that can
cause stress, but these are the stressors most commonly used in experimental research and most
commonly seen in the general population (Elliott and Eisdorfer, 1982).
While there is no way to predict conclusively how an individual will respond to different stressors, stress
does cause some common changes. Emotionally, stress can lead to feelings of depression, anxiety, and
anger (McEwen & Stellar, 1993). But even these seemingly simple reactions have high degrees of
expressivity, and different individuals are affected in different ways.
attack (Elliott & Eisdorfer, 1982). Even more importantly, interactions between antigens and
immunoglobulin E antibodies lead to the release of histamine, which blocks airways, and other
mediating agents (Elliot & Eisdorfer, 1982). When antigens have an easier time invading the body, as
they do under stress, the number of such interactions increases considerably.
Diabetes mellitus, the most common form of diabetes, is significantly affected by stress. Physical or
psychological stressors can alter insulin needs; stressors may often be responsible for episodes of loss of
control, especially in diabetic children. Type II diabetes is most often affected by stress, as it tends to
occur in overweight adults and is a less severe form of diabetes (Elliot & Eisdorfer, 1982). Additionally,
children who had stressful life events stemming from actual or threatened losses within the family and
occuring between ages 5 and 9 had a significantly higher risk of Type I diabetes (McEwen & Stellar,
1993).
Gastrointestinal diseases such as peptic ulcers and ulcerative colitis are known to be greatly influenced
by stress. Peptic ulcers occur twice as often in air traffic controllers as in civilian copilots, and occured
more frequently among air traffic controllers at high-stress control centers (Chicago O'Hare, La Guardia,
JFK, and Los Angeles International Airport) than at low-stress control centers (airports in less-populated
cities in Virginia, Ohio, Texas, and Michigan). Although stress is a major risk factor in peptic ulcers,
more than 20 other factors are thought to be associated as well; blood type, sex, HLA antigen type,
alcoholic cirrhosis, hypertension, chronic obstructive pulmonary disease, cigarette smoking, and even
consumption of coffee, carbonated beverages or milk during college (Elliott & Eisdorfer, 1982).
Ulcers are caused by excessive stomach acid, and studies of patients with gastric fistulas (openings
leading from the stomach to the outside of the body) have shown that anger and hostility increase
stomach acidity, while depression and withdrawal decrease it. Stress ulcers frequently occur in patients
who experience severe trauma, extensive surgery, major burns or infections, brain injury or surgery, or
other catastrophic events. Stress ulcers are quite different from peptic ulcers; they are acute, hemorrhagic
(bleeding), and are usually preceeded by shock (Ballieux, 1984).
Myocardial infarction (MI, or heart attack) is the best-known example of an acute health problem that is
usually precipitated by both acute and chronic physical or psychological stress. Interactions between diet
and stress lead to a condition that promotes endocrine imbalances that alter body fat distributions, as
well as increase atherosclerosis (plaque buildup in the arteries). Studies have shown that people with
Type A behavior (unusually aggressive, competitive, work-oriented, and urgent behavior) have a much
higher incidence of heart attacks than do Type B people, who exhibit fewer of these traits. In addition,
Type A behavior is associated with high cholesterol, triglycerides, glucocorticoids; a greater insulin
response to glucose; increased severity of coronary artery lesions; and greater range and magnitude of
blood pressure and catecholamine responses to timed tests (Elliott & Eisdorfer, 1982). As stated earlier,
stress increases catecholamines, and the increase of plasma catecholamines enhances platelet
aggregation, lowers the threshold to cardiac arrythmias, induces narrowing of the blood vessels, and
suppresses insulin secretion (McEwen & Stellar, 1993). All of these combined can lead to a very high
risk of heart attack or angina.
Psychological stress has also been shown to increase susceptibility to viral infection. Subjects exposed to
stress showed increases in infection rates from 74% to 90%, and clinical colds rose from 27% to 47%.
Earlier studies have shown that medical students have an increased risk of mononucleosis during
examination periods (McEwen & Stellar, 1993). This is not surprising, as stress does suppress the
immune system; latent viruses then have an easier time resurging, since the body cannot defend itself as
well (Brosschot, et al, 1994). This is supported by studies showing that colds and other infections
manifest themselves on weekends after busy and stressful work weeks. Additionally, studies on monkeys
have shown that ulceration showed up most severely during the rest and recovery periods, rather than
during the stress period itself (McEwen & Stellar, 1993).
In conclusion, psychological stress does have a significant affect on the immune system. It raises
catecholamine and CD8 levels, which suppresses the immune system. This suppression, in turn, raises
the risk of viral infection. Stress also leads to the release of histamines, which can trigger severe
broncoconstriction in asthmatics. Stress increases the risk for diabetes mellitus, especially in overweight
individuals, since psychological stress alters insulin needs. Psychological stress also alters the acid
concentration in the stomach, which can lead to peptic ulcers, stress ulcers, or ulcerative colitis. Chronic
stress can also lead to plaque buildup in the arteries, especially if combined with a high-fat diet. This
buildup is called atherosclerosis, and is often responsible for angina or heart attacks, which are usually
brought on by acute stress themselves. These diseases are by no means the only ones connected with
psychological stress, although they are the most common. Further research is needed to clarify exactly
how stressors contribute to each of these problems, so that treatment can be given to protect the body
from these diseases.