Heart Attack or Stress?

Warsaw_EN-US2451207088Emergency room or a chill pill? What is that sudden stabbing pain that lasts only a few seconds? Or that pressure on the chest that won’t go away and feels like it’s getting worse? A heart attack, heartburn or something else? Dramatic questions like these bring people to emergency rooms or doctors’ offices by the thousands every year. The stress caused by chest pains and severe discomfort in the area around the heart can be acute, and fear of the worst in fact augments the symptoms and brings on additional ones, such as sweating, dizziness, racing heart beat, and more.

But how can we tell when to seek emergency treatment and when to simply lay down and relax? Pain or severe discomfort centered around the heart can be caused by literally dozens of conditions, from pancreatitis, to pneumonia, to an anxiety attack. Given the variety of causes, some of which carry a lethal risk, it is not surprising that most people choose to consult a doctor. In fact, it may be the wisest thing to do, unless pain and discomfort subside in just a few minutes.

The most accurate (but slow) way to determine whether a person has experienced a heart attack is a blood test that identifies creatine kinase and cardiac troponin, chemical markers that appear in the blood stream when the heart muscle has sustained some damage. A faster (but less accurate) method is an electrocardiogram (ECG). The third method (the most immediately available but least accurate) is the person’s own description of the chest pain and any other symptoms to an emergency room physician.

The Harvard Medical Letter describes the following symptoms as generally indicating a condition other than a heart attack, including anxiety or stress:

  • sharp or knifelike pain brought on by breathing or coughing
  • sudden stabbing pain that lasts only a few seconds
  • pain clearly on one side or another
  • pain confined to one small spot
  • pain that lasts for many hours or days without any other symptoms
  • pain produced by pressing on the chest or with body movements.

These symptoms may not require a visit to the emergency room, especially if they resolve within a few minutes. When they persist longer, a doctor’s visit would be necessary to identify their exact cause and take the appropriate remedies.

On the other hand, the following symptoms may indicate a stronger likelihood that a heart attack is in progress and should be taken much more seriously:

  • sensation of pain, or of pressure, tightness, squeezing, or burning
  • the gradual onset of pain over the course of a few minutes over a diffuse area, including the middle of the chest, and its persistence
  • pain that extends to the left arm, neck, jaw, or back
  • pain or pressure accompanied by other signs, such as difficulty breathing, a cold sweat, or sudden nausea
  • pain or pressure that appears during or after physical exertion, or emotional stress, or while at rest.

The appearance of these symptoms would more clearly warrant a 911 call.

School Bullying Is Much More Than ‘Just What Kids Do’

aaMondrian_BroadwayIs school becoming an increasingly dangerous place for our children’s mental and physical health? A study of 43,321 high school students confirms that student-on-student bullying has become a serious problem in public and private schools across the United States. Its behavioral, health and social consequences are lowered academic achievement and aspirations, increased anxiety, loss of self‐esteem and confidence, depression and PTSD, general deterioration in physical health, self‐harm and suicidal thinking, feelings of alienation in the school environment such as fear of other children, and absenteeism from school. In response to recent high-profile bullying cases, the U.S. Department of Education has sent this letter to over 15,000 school districts across the country, in which school officials are reminded of their responsibility and legal obligation to protect the civil rights of all students, regardless of their nationality, race, sex or disability status.

The study, conducted by the Josephson Institute of Ethics, was released on Tuesday and is the largest ever undertaken of the attitudes and conduct of high school students. The truly sobering results show that 50% of all high school students admit they bullied someone in the past year, and 47% say they were bullied, teased, or taunted in a way that seriously upset them in the past year. 33% percent of all high school students say that violence is a big problem at their school, and 24% say they do not feel safe at school. 52% admit that within the past year they hit a person because they were angry. 10% of students say they took a weapon to school at least once in the past 12 months, and 16% admit that they have been intoxicated at school. The study clearly shows that there is almost no difference between public, religious private and non-religious private schools in the students’ perceived safety, or in the percentage of perpetrators and victims of bullying.

In the press release accompanying the results, Institute Director Michael Josephson said, “If the saying, ‘sticks and stones will break my bones but names will never harm me’ was ever true, it certainly is not so today. Insults, name calling, relentless teasing, and malicious gossip often inflict deep and enduring pain. It’s not only the prevalence of bullying behavior and victimization that’s troublesome. The Internet has intensified the injury. What’s posted on the Internet is permanent, and it spreads like a virus – there is no refuge. The difference between the impact of bullying today versus 20 years ago is the difference between getting into a fist fight and using a gun. The combination of bullying, a penchant toward violence when one is angry, the availability of weapons, and the possibility of intoxication at school increases significantly the likelihood of retaliatory violence.”

When Stress Hurts: Neurochemistry Cognates

In this third post in the series on the close association between psychological stress and psychogenic pain, we take a look at neurochemical substances that are involved in the process of psychogenic pain generation and reaction to psychological stress.

The Neurochemistry of Pain: Substance P

aaGiotto_DeposizioneSubstance P, discovered in the 1950s, is the quintessential pain neurochemical, which is activated in response to physiological pain as well as to psychological stress (DeVane, 2001). It is a prototypic neuropeptide of the tachykinin family that has been linked to the production of over 50 neuroactive chemical substances (Brain & Cox, 2006). Its best documented role is as the modulator of signals to nociceptive neurons that communicate the intensity of noxious or adverse stimuli, not only those caused by pain but also those produced by psychological stress (DeVane, 2001; Shaikh, Steinberg, & Siegel, 1993). Substance P receptors are found throughout the CNS but especially in the substantia gelatinosa of the dorsal horn, which is the first point of arrival of afferent pain signals to primary nociceptive fibers.

It is not coincidental that Substance P is also present in the limbic system of the CNS, in the hypothalamus and in the amygdala, all structures that are closely associated with the perception and processing of emotions (Bannon et al., 1983; Culman & Unger, 1995; DeVane, 2001; Stahl, 1999).

Some purely psychological and psychogenic reactions of the organism also see the involvement of substance P, such as the vomiting reflex, anger and defensive behaviors (Krase, Koch, & Schnitzler, 1994), changes in cardiovascular tone (Black & Garbutt, 2002), stimulation of salivary secretions, and other physiological responses that are associated with the general adaptation of the body (Selye & Fortier, 1950) to stressful stimulation.

Kohlmann and colleagues (1997) reported the discovery of substance P in blood pressure regulation in individuals with essential hypertension, a condition that has been related to maladaptive responses to stress (Palomo et al., 2003) and has been shown to respond to psychotherapeutic interventions (Amigo, Buceta, Becona, & Bueno, 1991). Other evidence of the concurrent role of substance P in signaling pain and in the stress reaction comes from animal studies that show an array of defensive behavioral and cardiovascular changes in animals subjected to stressful stimulation (Krase et al., 1994), as well as the detection of substance P in the amygdala of laboratory animals upon neonatal separation (Kramer et al., 1998).

The Neurochemistry of Stress

The neuroendocrine response to a real or perceived stressor consists of the near simultaneous release by the sympathetic nervous system (SNS) of the catecholamines norepinephrine (NE) and epinephrine, the release by the hypothalamus of corticotrophin releasing hormone (CRH), the inhibition by the hypothalamus of gonadotropin releasing hormone (GnRH) and pituitary gonadotropins, the release by the pituitary gland of prolactin (PRL), and the release by the pancreas of glucagon (Sapolsky et al., 2000).

Upon release of NE into the synaptic cleft, approximately 10% of it enters the plasma, thus making plasma NE levels one of the most reliable measures of SNS activity and the magnitude of the body’s response to stressors. Peroutka (2004) has proposed that a migraine attack may be triggered by a significant decrease of NE due to the excessive or prolonged release of adenosine, dopamine and prostaglandin by the over-stimulated SNS. Since sympathetic activation is the primary component of the stress response, stress is thus unequivocally linked to the onset and maintenance of migraine headaches.

The Closest Association: Stress-Induced Analgesia

Livingstone_LionRThe body’s reactivity to real or perceived stressors provokes measurable changes in the autonomic nervous system (ANS) and in the structures controlled by the hypothalamic-pituitary-adrenal (HPA) axis. These changes include blood pressure elevation, pupil dilation, and secretion of cortisol. In the presence of a significant stressor, the stress response also includes a “stress induced analgesia,” or a decreased sensitivity to further pain (as writer-explorer David Livingstone so eloquently reported). This antinociceptive action of the ANS translates into an inverse relationship between blood pressure and pain sensitivity in animals and humans, and is designed to maintain the integrity of the body’s defense systems. Additionally, the release of CRF by the hypothalamus has known analgesic effects (Okifuji & Turk, 2002).

The ANS was recognized by Cannon (1914; Cannon, 1933) as the originator and enabler of the “fight or flight” response to stress. Stress-related releases of adrenaline stimulate the feedback provided by the afferent and efferent vagal fibers. Once again, these same fibers are involved in the activation of endogenous pain modulation centers (Bielefeldt, Christianson, & Davis, 2005). Pain and stress just seem to go together.

Previously in this series:

Next:

  • Psychological Stressors and the Sudden Appearance of Psychogenic Pain
  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain

Beyond Reaction: An Intelligent Response to Stressors

aaAltdorfer_SusannaElternA stress reaction that gets “stuck” into alarm mode and never progresses toward a resolution of the stressor can develop into chronic stress or depression. The latter can be conceptualized as turning inward, shutting off the world and avoiding all but the most necessary contact with the stressor. It is a rather primitive and ultimately ineffective way of coping with stressful events and situations (for better ways of defending against stress see this post), but it is undeniable that it works at reducing the level of incoming inputs and the effort required to respond. When stress causes anxiety, what follows is a semi-permanent state of arousal (which can have dangerous health consequences). When the response is depression, what follows is a significant reduction in functioning—to the extent that the person is not anxious but apathetic, withdrawn, and unresponsive even to positive stimulation.

The Coping with Stressors Inventory

Adapted from the Coping Styles Questionnaire (CSQ) by Roger, Jarvis, & Najarian, (1993), this is a simple way to determine our instinctive and preferred ways of managing stressors as they appear in our lives. These are ways that are characteristic of our behavior and are most likely to be used under conditions of severe stress.

Instructions: Mark as many as apply, but make sure to choose only the ones that you are most likely to use or have definitely used in coping with severe stressors.

When I am confronted with a severe or continuing stressor:

1. I ignore my own needs and just work harder and faster.
2. I seek out friends for conversation and support.
3. I eat more than usual.
4. I engage in some type of physical exercise.
5. I get irritable and take it out on those around me.
6. I take a little time to relax, breathe, and unwind.
7. I smoke a cigarette or drink a caffeinated beverage.
8. I confront my source of stress and work to change it.
9. I withdraw emotionally and just go through the motions of my day.
10. I change my outlook on the problem and put it in a better perspective.
11. I sleep more than I really need to.
12. I take some time off and get away from my working life.
13. I go out shopping and buy something to make myself feel good.
14. I joke with my friends and use humor to take the edge off.
15. I drink more alcohol than usual.
16. I get involved in a hobby or interest that helps me unwind and enjoy myself.
17. I take medicine to help me relax or sleep better.
18. I maintain a healthy diet.
19. I just ignore the problem and hope it will go away.
20. I pray, meditate, or enhance my spiritual life.
21. I worry about the problem and am afraid to do something about it.
22. I try to focus on the things I can control and accept the things I can’t.

Results Evaluation: Even-numbered ways of coping are more constructive, while the odd-numbered ones are less constructive tactics for coping with severe or continuing stressors. Checking more even-numbered items indicates a better approach to stressors that takes into account the need for self-care, emphasizes the seeking of support, and confronts the stressor in effective ways. If more odd-numbered items are checked, this may indicate an attempt to cope with stressors by avoidance, smothering the stress reaction with chemical means, and generally retreating into tactics that may temporarily reduce the symptoms of stress but fail to address the causes.

When Stress Hurts: Central Nervous System

In establishing the connection between the onset of psychogenic pain and stress, it is important to notice that pain and stress share the same central nervous system (CNS) pathways and structures. In this second post in the series on the close association between psychological stress and psychogenic pain, we’ll take a look at these shared structures.

CNS Structures Mobilized by Pain and Stress

PendulumThe body’s response to pain engages a large number of CNS structures that are often the same as the ones activated by the stress reaction. The afferent pathways that carry pain signals connect to the thalamic nuclei and from there to the somatosensory, insular and anterior cingulate (ACC) portions of the brain cortex. A recent functional MRI (fMRI) study (Keltner et al., 2006) on the effects of pain expectation on pain transmission provides the best evidence for the activation of the rostral ACC (rACC), periaqueductal gray (PAG), and medial prefrontal cortex. This and other imaging studies provide evidence of a bidirectional pain pathway receiving input from the limbic system and the amygdala, converging on the PAG, traveling through the pontomedullar nuclei, and controlling spinal pain transmission neurons (Fields, 2000; Fields & Martin, 2001). As the authors of this study point out, “expectation for a higher intensity noxious stimulus increases subjectively experienced pain intensity in part through the action of a descending pathway that facilitates nociceptive transmission at and/or caudal to the region of the contralateral nucleus cuneiformis (nCF)” (p. 4442). The nCF, in humans and other primates, has a composition similar to the PAG and its neurons project directly into the rostroventral medulla, the hypothalamus and the amygdala, all structures directly involved in modulation of the stress reaction.

PMR_muscle-crampsLikewise, the body’s stress response engages a large number of the same CNS structures, specifically certain subregions of the hypothalamus such as the paraventricular nucleus (PVN), the amygdala, and the periaqueductal grey; and certain cortical brain structures, such as the medial prefrontal cortex and subregions of the anterior cingulate and insular cortices (Maier, 2003). These structures provide output to the pituitary and pontomedullar nuclei, which in their turn stimulate the body’s neuroendocrine secretions, as well as to the hypothalamic-pituitary-adrenal (HPA) axis, the endogenous pain modulation system, and the ascending aminergic pathways. The feedback controlling the stress response is provided by the serotonergic (raphe) and noradrenergic (locus ceruleus) structures and by the levels of glucocorticoids in the blood stream, which provide inhibitory impulses to the medial prefrontal cortex and to the hippocampus. Corticotrophin releasing hormone (CRH) is the fundamental chemical substances mediating the stress response, which is secreted by PVN, amygdala, and locus ceruleus neurons. Acute or chronic stress can temporarily or permanently modify the level of responsiveness and output of the CNS to stress (Bennett et al., 1998).

Sharing Pathways, Sharing Outcomes

With this significant convergence of pathways, neurochemical activity and CNS structure activation, it should come as no surprise that acute stress can provoke physical pain, often in the head, the muscles, and the abdominal region. Equally unsurprising is that pain, especially when sharp and unexpected, is in itself a cause of stress that mobilizes the body into immediate action (think of the hand that immediately goes to cover the cut or the burn). Continuous pain, of any origin, is inherently stressful. Continuous stress can be, and often is, manifested by otherwise unexplained (thus psychogenic) physical pain.

Previously in this series: When Stress Hurts: Psychogenic Pain

Next:

  • The Neurochemistry of Psychogenic Pain and Stress
  • Psychological Stressors and the Sudden Appearance of Psychogenic Pain
  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain

Deflation: Chronic Stress on a National Scale

Palmyra_EN-US856764098"The economy isn’t recovering fast enough." One of the principal reasons is that sales of anything, from houses to double no-foam lattes, are down or flat across the board. American consumers are worried about their personal financial health, their jobs (or lack thereof), their families’ future, the sorry state of the economy, gridlock in Washington, and the fear of another bank/mortgage/stock market crash.

The piling up of this real heap of trouble over the last couple of years has caused most Americans to go into stress reaction mode: fight, flight or freeze. The evidence is mounting that most are choosing to freeze. Businesses that sell goods and services report flat or lower sales to fewer buyers. In a so far vain attempt to get the consumer economy moving again, prices have been and continue to be reduced through special offers, discounts, two-fers and other creative ways meant to entice more buyers.

As consumers refuse to take any risk, either because of their worries or simply waiting for prices to fall further, deflation may now be setting in. Deflation is the opposite of inflation and defines a situation when prices are mostly falling, sales stagnate or fall, with "lower business profits, which lead to layoffs and lower consumer spending and further price declines. [Deflation] makes it more difficult to pay off debt because the value of debt rises relative to income. It provokes hoarding, as consumers, businesses and banks hold on to cash, expecting that prices will keep falling," as characterized by the New York Times. In short, the paralysis of freeze

So it is that unending economic turmoil since 2008, record-high job losses, stagnating or falling employment, and the double-whammy mortgage/foreclosure crisis appear to be provoking one of the most severe stress reactions in generations, in individuals, families, and businesses across the nation. While a few are now fighting to get the economy moving again, a significant number may have left the fight and given up trying, and many more still could be just frozen in place, unable to move forward with their decisions, investments, and major purchases.

As understandable as it may be, this nationwide stress reaction is just what it is, a reaction. It is not a formulated response against a severe and persistent set of stressors, which would require the exercise of sound judgment, decision-making and risk-taking. Instead, the risk to the US economy is that this reaction may become chronic and take years before progressing toward an effective response.

The red lights are flashing and the alarm bells are ringing, urging meaningful action that will address the emergency. Not much appears to be happening. Until the paralysis of freeze is overcome and a real response begins, the alarm bells will continue to ring, while deflation takes hold. Chronic stress, on a national scale.

When Stress Hurts: Psychogenic Pain

PendulumThis post kicks off a Stresshacker series on the close association between psychological stress and psychogenic pain. Psychogenic pain is by definition a physical pain that can only be associated with psychological stressors. Psychogenic pain is said to occur when all possible organic causes of pain are ruled out and its symptoms cannot be associated with a medically diagnosed condition. There can be a stigma associated with this type of pain as being “all in one’s head,” and the suffering it causes has often been discounted or dismissed as unexplainable and therefore not treatable with conventional medical approaches.

I’m 23, and have had chronic pain since I was in middle school. Doctors always brushed it off, saying it was "growing pains" or "all in my head." About two years ago, I was given the diagnosis of fibromyalgia. I felt like that doctor visit was a waste of time. I certainly do believe that fibromyalgia is a real condition, but that was not what was wrong with me. Doctors are quick to throw some label on patients to placate them… — Mrs. Smith of SC @ Aug 21, 2010 21:20:28 PM

Pain, of any kind, is a complex peripheral and central nervous phenomenon that acts as a signaling mechanism, usually indicating the presence of injury or disease. The International Association for the Study of Pain (IASP) defines pain as, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is more than just physical since, like all human experiences, it includes a cognitive and emotional component.

spinozaThe 17th century philosopher Spinoza recognized the emotional and physical valence of pain when he defined it as a “localized form of sorrow.” This definition is particularly appropriate when pain is present in all its debilitating intensity and does not appear to be a sign of injury or a diagnosable illness.

The persistence of unexplained pain to shoulders, upper arms, lower arms, hips, upper legs, lower legs, jaw, chest, neck, or abdomen can lead to a diagnosis of fibromyalgia especially if associated with other symptoms such as irritable bowel syndrome, fatigue, anger and sadness, problems thinking or remembering, muscle weakness, abdominal pain or cramping, numbness or tingling, dizziness, insomnia, depression, constipation, nausea, nervousness, chest pain, fever, dry mouth, itching, frequent or painful urination, or wheezing. Treatment for fibromyalgia can range from powerful prescription pain killers (which can be dangerously addictive) to gentler and often as efficacious non-medical approaches such as psychotherapy and tai chi.

That a reciprocal association exists between psychological stress and unexplained pain symptoms has long been observed in clinical settings. A significant number of patients suffering from psychogenic pain also complain of stress, often made worse by other psychological disturbances such as depression or anxiety disorders.

A review of recent medical literature on pain and stress yields strong evidence for increased sensitivity to stress in patients with psychogenic pain, and vice versa. Studies conducted in the last decade suggest that psychogenic pain and stress are psychological and sensory experiences that require a multidisciplinary, biopsychosocial approach in their treatment.

Next in this series:

  • Psychogenic Pain, Stress and the Central Nervous System
  • The Neurochemistry of Psychogenic Pain and Stress
  • Psychological Stressors and the Sudden Appearance of Psychogenic Pain
  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain

Army Suicides Highest Ever and Rising

aaCarignano_CrimeaThe number of suicides among active duty US soldiers is very high and it is rising at a faster rate: 125 Army soldiers have taken their own lives in the first eight months of this year. If suicides continue at this pace they will exceed the total for 2009, when there were a record 162 suicides. The trend shows little sign of abating, despite a now 20-month-old suicide prevention program and work aimed at removing the stigma of psychological counseling, the New York Times reports

Medical corps Army officers familiar with the situation have identified several factors that may be involved in the rising rate of suicides. While there is a widespread belief that repeated deployments are the principal cause of suicides, Army records show that 80% of soldiers who killed themselves were deployed in combat zones only one time or not at all. A significant number of the soldiers had experienced serious problems in their marriage. Many had sought counseling from Army psychologists for anxiety and posttraumatic stress symptoms. Interviews with family members indicate that in many cases, the soldiers believed that a diagnosis of posttraumatic stress disorder would ruin their careers. Additionally, many believed that their counselor or psychologist would not treat their condition as confidential, but would convey up the chain of command what the soldiers reported in private counseling sessions.

Expectant Mother Stress and the Unborn Child

JapaneseGarden_EN-US1668112966Stress during pregnancy is usually discussed in negative terms and fear and anxiety seem to be the rule in explaining its possible consequences. A recent and soon to be published study by Janet Di­Pietro suggests that, at least in part, the contrary may be true. DiPietro, an internationally recognized leader in the field of child development, is credited with having described for the first time the ontogeny of human fetal brain–behavior relations throughout gestation, the associations of maternal and fetal characteristics with the neurobehavioral maturation of the fetus, and the fetal neurobehavioral origins of individual differences in infant physiology and behavior. Her latest study shows that 2-week-old infants of women who experience relatively more stress during pregnancy showed faster neural conduction, “evidence of a more mature brain.” Thus, maternal stress during pregnancy may actually stimulate the unborn child’s brain development, suggesting that the dreaded nefarious effects of stress on the child may be simply a matter of degree.

In her other studies, DiPietro outlined evidence to support the notion that the effects of maternal stress on the unborn child are actually quite modest in magnitude, pointing out that the placenta breaks down the stress hormone cortisol in the woman’s blood, preventing most of it from reaching the fetus. However, she is also careful to note that maternal stress may directly influence the developing fetal nervous system; that these effects on brain development may be aggravated over time by various characteristics of postnatal development; and that existing research on the effects of maternal prenatal/perinatal stress on child development lacks conceptual and methodological consistency and scientific rigor.

[amtap book:isbn=0743296621]

Science writer Anne Murphy, author of the recently published new book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, classifies prenatal stress as belonging to the “profoundly unsatisfying” category of “it depends.” While describing her second pregnancy, Paul traces the developing literature on fetal origins, which has been called the staging ground for well-being and disease in later life. In her chapter on stress, she cites the existence of 200 industrial chemicals that can be found in babies’ umbilical cords, the link between low birth weight and later cardiovascular disease, and raises the possibility that a dietary supplement might one day protect future children from cancer.

Her focus on how expectant mothers can minimize harm to their unborn child during pregnancy makes Paul’s book a fascinating read that will help understand and put into perspective the opportunities and dangers of this fascinating period. It is the Stresshacker Recommended book for this week.

ADHD Breakthrough: Not Just Bad Behavior

IntlSpaceStation_EN-US2825695802 Attention-deficit/hyperactivity disorder (ADHD) is a genetic, neurodevelopmental disorder and not just a behavioral problem. In a study published online in the Sept. 30 issue of The Lancet, investigators from the University of Cardiff in the United Kingdom say their findings show that ADHD has a genetic basis. In the genome-wide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls without the condition were included. Researchers found that compared with the control group without ADHD, children with the disorder were twice as likely — approximately 15% vs. 7% — to have copy number variants (CNVs). CNVs are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).

The breakthrough results of this study should help in the controversy as to whether ADHD is a "real disorder" or simply the result of bad parenting, in shifting public perception about ADHD and promoting further research into the biological basis of the disorder with a view to developing better, more effective therapies for affected individuals.

Can Environmental Stress Control Our Genes?

A_coign_of_vantage Environmental stress can destroy protective complexes in human cells and turn on or off selected genes, newly published research shows. External stress agents appear to “instruct” certain enzymes to modify gene behavior, whereby genes that should remain turned off are activated and disturb the development, functioning and growth of human cells. According to Dr. Simmi Gehani, principal researcher at the University of Copenhagen where the study was conducted, this means that external stress factors can control the activity of our genes.

Why is this important? The specific knowledge of how our genes are regulated is important in order to understand how stress can lead to development of disease. The genetic code contained in our DNA is the same as in the over 200 cell types found in our body. Based on the “instructions” contained in our DNA, individual cells develop in different and highly specialized ways. Many genes are only active at specific times during fetal development or in specific cell types in the adult body. The natural deactivation of certain genes at specific time points ensures normal development and maintains proper cellular identity and function.

The new research findings, published in the latest edition of Molecular Cell, show that stress-activating factors can turn on genes that were supposed to remain inactive. These external stress factors are pollution, tobacco smoke, alcohol, drugs, chemical contaminants, or bacterial toxins. They can put a significant stress load on cells, which must react to survive and maintain their normal function. These research findings may help explain the effects that environmental stressors can have on health and functioning.

Additionally, they may also explain the dangers of external stressors to the unborn. During fetal development, exposing human cells to a stress-activating agent can turn on previously inactive genes. This is significant because even small changes in gene activation can have disastrous effects in child development.

There is a widespread belief — often dismissed — that what happens during pregnancy can affect everything that a person becomes in life. This and other research, writes Annie Murphy Paul in her new book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, may provide evidence to support the claim.

A Woman’s Stress Relief: Tend-and-befriend

ElGreco on Stresshacker.com Reaching out vs. retreating appears to be what distinguishes the instinctual reaction to stress between men and women. For women, the choice between fight or flight in the presence of a stressor applies less frequently than tend-and-befriend.

Whereas the typical male is more likely to narrow his response to stress down to a decision whether to fight the stressor directly and aggressively or retreat from it by way of an emotional withdrawal, most women choose to turn to family and friends by tending to or cultivating connections. Forming a network of support appears to be an innate characteristic of females also among primates, intended as a form of protection for themselves and their offspring. Clearly, the assumption is that there is more safety in numbers than in trying to make it alone in potentially dangerous situations.

Most women naturally construct a more intimate and complex social network than men do, and when they are stressed, in danger, or in times of change, they can turn to this network for support. Thus, they are more likely to seek out the company of other women and less likely to flee the stressor by withdrawing or isolating or to fight it directly and single-handedly, as most men appear to do.

This natural response to the stress reaction, moderated by a support system such as tend-and-befriend, might help explain why women live an average of five years longer than men. Men are also capable of creating complex social networks (now enormously facilitated by technological connectivity), but male-created social networks may lack the necessary level of intimacy or remain underutilized as a coping mechanism.

The Science Behind Tend-and-befriend

Research being conducted at UCLA under a grant by the National Science Foundation on Biopsychosocial Bases of Social Responses to Threat indicates that, in times of danger, most people seek positive social relationships that may provide safety for themselves and their offspring.  This and prior research by Dr. Shelley Taylor at UCLA’s Social Neurosciences Lab suggests that the hormone oxytocin and other opioid peptides produced in the body stimulate these responses, most especially in women. Oxytocin in particular appears to function as a social thermostat that monitors the availability of social resources and prompts the seeking of additional connections when needed.