May-June 2013 | Features in Bethesda Health

Stress: It's Sickening. Really.

In the high-pressure environs of Bethesda, the 'plague' of our generation is claiming plenty of victims

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In the 1990s, Jennifer Stein was a litigation associate at a large D.C. law firm, working long hours, traveling extensively and “experiencing tons of pressure to be at the top of my game,” she recalls. “Then I got a great opportunity to argue an appeal in front of the U.S. Court of Appeals for the D.C. Circuit. It was a big deal and very exciting—but very, very stressful.”

As she was preparing for oral arguments, Stein began feeling increasingly ill. She’d had Crohn’s disease—an autoimmune disorder and chronic inflammatory condition that affects the gastrointestinal tract—since age 17, and it consistently flared up when she was under stress. The pain in her digestive tract became overwhelming, and she lost so much weight over the course of months that colleagues wondered if she had an eating disorder.

“I pulled off the oral arguments and we won the case,” says Stein, now 46 and the mother of two in Chevy Chase. “But my health never completely rebounded after that.”

Work deadlines, financial worries, the threat of layoffs, constant traffic and road construction, the pressure to raise healthy and successful kids, the ongoing crunch of too much to do in too little time—the list goes on. Ask Bethesda-area residents whether they’re under stress, and the answer is likely to be: Of course! Who isn’t? Stress has become a fact of modern life here—and as Jennifer Stein discovered, it takes a toll.

“Washington, D.C., is a very high-powered place, where people are making high-stakes decisions all the time and working very hard. It’s also the No. 1 worst commuting place in the country,” notes Dr. Norman Rosenthal, a psychiatrist based in North Bethesda and author of Transcendence: Healing and Transformation Through Transcendental Meditation (Tarcher, 2012).

“The stressors are abundant, and the turndown in the economy is making it difficult for people to live as well as they thought they would,” he adds. “A stressed life is not a happy life, and I don’t think people realize the extent to which stress can harm their health.”

An estimated 75 percent to 90 percent of doctor visits are related to stress, according to The American Institute of Stress (AIS), which is based in Fort Worth, Texas. Perhaps that’s why it’s being called the “21st-century equivalent of the Black Death” by some media outlets. Stress costs American companies more than $300 billion per year as a result of direct medical and insurance expenditures, accidents, workers’ compensation awards, absenteeism, employee turnover and diminished productivity, according to the AIS.

As Stein found with her digestive issues, stress is likely to manifest “wherever you’re vulnerable,” says Dr. James Gordon, founder and director of The Center for Mind-Body Medicine in Upper Northwest D.C. and author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression (Penguin Press, 2009).

“Many people get musculoskeletal pain—headaches, neck pain, back pain—while others have their blood pressure go up or develop symptoms of diabetes,” Gordon says. “There is a constitutional or genetic factor, plus environmental and lifestyle factors—such as physical exercise, your eating habits and social connections—that can affect your vulnerability.”

Just ask Stacy Berman, a real estate agent and mother of two in Chevy Chase who often experiences asthma attacks and asthmatic bronchitis when she gets overtired and overstressed.

“I tend to run at 150 mph and ignore my asthma warning signs,” she says. “Then my body crashes and I’m flat out in bed for a week and I have to go on steroids and antibiotics.”

Similarly, a Rockville litigator gets flare-ups of irritable bowel syndrome whenever he goes to visit his parents out of state. “My mother is incredibly critical and difficult—and whenever I spend time with my parents, I get stressed out and end up spending a lot of time in the bathroom,” says the man, who didn’t want to be identified. “Going to court is easy by comparison.”  

Stress literally can affect us from head to toe. It affects levels of neurotransmitters and neuronal function in the brain, our immune response, as well as the way our heart, muscles and lungs work. What’s more, “chronic stress can contribute to hormonal imbalances—involving cortisol and insulin, in particular—and low-grade, dysfunctional inflammation,” says Dr. David Katz, director of the Yale-Griffin Prevention Research Center in Derby, Conn.

As a result, chronic stress can increase a person’s risk of developing diabetes, cardiovascular disease and other life-threatening conditions over time, he says.

The human stress response is a powerful evolutionary instinct. At the first sign of a serious threat to our well-being, our bodies are primed either to fend off a wild animal or to run for our lives. The hypothalamus in the brain triggers the release of stress hormones, such as adrenaline, that cause the heart rate to speed up, blood pressure to rise, eyes to dilate and muscles to contract.

All of that is incredibly helpful if our physical safety is threatened—but not so much in dealing with a difficult boss or a dwindling bank balance. Complicating matters is the fact that “we used to have some compartmentalization in our lives. Now, we’re really on a 24/7 cycle, which becomes a driver and creator of stress,” says Laurie Cameron, a leadership consultant and executive coach based in Chevy Chase who frequently works with people on managing stress.

The body’s stress response doesn’t always cease after a trying event ends, either. Instead, it can get stuck in the “on” position after chronic or repeated stress, leading to persistent, low-grade inflammation, hormonal imbalances, and the production of harmful free radicals. Those changes can wreak havoc with your skin, digestive system and other organs, causing new symptoms or exacerbating existing conditions.  

Some people react more strongly to stress than others, of course. Researchers at the University of Bergen in Norway recently examined the relationship between psychological hardiness—defined as the amount of control, commitment and positive challenge people feel in their lives—and a person’s neuroimmunological responses to a stressful exercise. The participants who scored high in commitment and control but lower in terms of embracing challenges were more reactive to stress, exhibiting less healthy immune and neuroendocrine markers than those who were truly hardy.

None of this is to say that stress is entirely bad. “Stress is essential for life: No organism is able to survive without having to coordinate a reaction to a threat,” says Dr. Constantine Stratakis, scientific director of the Eunice Kennedy Shriver National Institute of Child Health & Human Development in Bethesda. “It’s a reaction that affects all systems of the body, but every system has a different threshold” for when stress becomes harmful.

Dr. Hans Selye, an Austro-Hungarian endocrinologist and one of the early pioneers of modern stress theory, coined the term “eustress” in the 1930s to describe the flip side of negative or harmful stress. Eustress is essentially stress without distress. It enhances a person’s ability to function, and the challenges or stimulation it provides often lead to feelings of personal fulfillment. An example is that career-boosting presentation at work, versus having to deal with a mercurial boss who blindsides you with unreasonable demands.

“The difference between eustress and distress is empowerment—whether you feel in control of your destiny or like these challenges are taking over your life,” Katz says.  

With the latter, continuously overdosing on stress hormones can leave a lasting imprint on the endocrine system, brain and other parts of the body over time, Stratakis says. It’s similar to what can happen when a button is depressed so many times that it no longer pops up the way it should.

And there’s a trickle-down effect throughout the body. Too much free-flowing adrenaline can lead to continuous surges in blood pressure, which can damage blood vessels in the heart and brain. Excess cortisol can inhibit immune function. That’s one reason people under chronic stress often recover from illnesses more slowly than others. It’s also why some people suffer from chronic skin conditions such as psoriasis, rosacea, acne, rashes, itching and hair loss.

“The onset of these conditions may also occur during periods of psychological stress,” says Chevy Chase resident Dr. Alison Ehrlich, chair of the department of dermatology at George Washington University.

Other people develop serious muscle tension, which can trigger or magnify a variety of pain-related conditions when they’re under intense stress.

After being dragged into a five-month internal investigation at her company a few years ago, a Potomac woman started clenching her jaw. That led to chronic headaches and neck pain. She also came down with gastroesophageal reflux disease (GERD), an ulcer in her esophagus and chronic insomnia.

“During the ordeal…I could keep it together,” she says. But “after it was resolved and I was fully cleared, my body broke down and my health flipped. I’ve never really bounced back from this. I haven’t slept well in years, and I still have chronic headaches and neck pain.”