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Conceptualizing Stress Disorders and the Physiology and Purpose of Emotions
Abnormal Psychology · Chapter 13: Stress-Related Disorders and Emotional ResilienceSection 13.1 · lesson 47 of 9720 min · free with a free account
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In this lesson
Why the capacity to switch off matters more than the size of the response.
- Separate a stressor, a stress response, and strain
- Describe the fast and slow physiological pathways
- State what chronic stress evidence does and does not license
- Explain what emotions are and what functions they serve
Transcript
Everything said in the video, section by section (2,669 words). Read along, or search it.
Stress-Related Disorders and Emotional Resilience
Conceptualizing Stress Disorders and the Physiology and Purpose of Emotions
Two people have the same shock. One is fine by lunchtime; the other is not fine for a year. The difference is usually not the size of the response. It is whether the response ever switched off. That idea runs through this whole section, and through the rest of the chapter. We start by separating three things the word stress is doing at once. Then the two physiological pathways, one fast and one slow. Then what the evidence on chronic stress does, and does not, license anyone to say. And we finish with emotions. What they are made of, and what they are for.
Defining Stress
Three Words Doing One Word's Work
Stress is used in at least three incompatible ways in ordinary speech. People say they are under stress, meaning the demands on them. That they are experiencing stress, meaning their reaction. And that a period was stressful, meaning something about the relationship between the two. The field separates these deliberately. A stressor is the demand itself. An event, a condition, a circumstance requiring adaptation. It is external to the response, and it is not stress. The stress response is what the organism does. The physiological, emotional, cognitive, and behavioral changes that follow. And strain is the cost of sustaining that response over time. The wear, rather than the reaction. The definition the field works with now is transactional. Stress is a relationship between a demand and a person's perceived capacity to meet it. Not a property of either one alone. That matters, because it explains something a stimulus-based definition cannot. The same event produces very different responses in different people. And in the same person at different times. Two more terms. Eustress is demand appraised as challenging rather than threatening. Distress is demand appraised as exceeding capacity. The physiology overlaps substantially between them, which is itself informative. What differs is the appraisal, not primarily the machinery. One note first. This material is educational, and is not a basis for changing any medical care you receive.
Fast Pathway
Fight or Flight, in Seconds
The fight-or-flight response is rapid mobilization of the body for vigorous action. It runs along the sympathetic-adrenal-medullary pathway, and it operates in seconds. The hypothalamus signals the sympathetic branch of the autonomic nervous system. Sympathetic nerves carry that signal directly to organs throughout the body. Which is exactly why the response is so fast. It is a neural signal, rather than a chemical one traveling in the blood. The same signal reaches the adrenal medulla, the inner portion of the adrenal glands. That releases adrenaline and noradrenaline into the bloodstream. Those sustain and amplify the effects the nerves have already begun. Now the bodily changes, and every one makes sense as preparation for physical exertion. Heart rate and force of contraction increase. Blood is redirected toward skeletal muscle, and away from the digestive system. Airways widen, increasing the rate at which oxygen can be taken in. Stored fuel is released into the blood, making energy immediately available. Pupils widen, and attention narrows toward the source of threat. Digestion, growth, and reproductive activity are suppressed. Those are expensive processes with no short-term value in an emergency. And blood clotting capacity increases, which is useful in the event of injury. Now read that list against the experience of anxiety. Racing heart, breathlessness, dry mouth, digestive disturbance, narrowed attention. Those are the same events, described from inside. Which is why the presentations in chapter eleven have the bodily character they do.
Slow Pathway
The Axis That Switches Itself Off
The hypothalamic-pituitary-adrenal axis is the slower hormonal route. It operates over minutes to hours, and can sustain a response far longer than the fast pathway. It is a chain of three glands, each signaling the next chemically. The hypothalamus releases a releasing hormone into a local blood supply reaching the pituitary. The pituitary responds by releasing a hormone into the general circulation. And the adrenal cortex responds to that by releasing cortisol. Cortisol makes energy available and sustains the response. It mobilizes stored fuel, alters immune activity, and affects a wide range of tissues. It is frequently described in popular writing as harmful, and that is a misunderstanding. Cortisol is essential. It follows a daily rhythm independently of any stressor. The concern here is with sustained elevation, not with the hormone itself. Now the most important structural feature of the axis. Feedback regulation. Cortisol acts back on the hypothalamus and the pituitary, to reduce their output. A negative feedback loop. The system is built to switch itself off. And that is where this account connects to everything that follows. What goes wrong in sustained stress is frequently not that the response is too strong. It is that the response does not terminate. Recovery is the other half. Parasympathetic activity returns the body toward baseline. The capacity to switch off matters as much as the capacity to activate. An intense response that resolves promptly is adaptive, and costs little. The same response sustained is where the cost accumulates. Two people with identical peak responses can differ entirely in what those responses cost them. And the difference is in recovery.
Selye
What Survived, and What Did Not
The general adaptation syndrome is Selye's account, from the mid twentieth century. It describes how an organism responds to sustained demand. It is here because it is historically foundational, and its vocabulary is still in use. It has also been substantially qualified since, and both halves matter. Three stages were proposed. Alarm is the initial mobilization. Resistance to demand briefly drops as the response is organized, and then rises sharply. That brief dip is easily missed, and it is the model's most specific prediction. Resistance falls before it rises, because mobilizing a response itself takes resources. In the resistance stage, resistance is sustained above the normal level while demand continues. The organism copes, at a cost that is not visible from outside. In exhaustion, the resources supporting resistance are depleted. Resistance falls below normal, and the organism becomes vulnerable. Now the claim that did not survive. Selye's most distinctive proposal was that the response is non-specific. That the same sequence follows any sufficiently intense demand, whatever its nature. That has not held up in the strong form in which it was made. Stress responses are considerably more stimulus-specific than it allowed. The pattern of hormonal and autonomic activation differs by the type of demand. By whether the situation is controllable, by whether it is socially evaluative, and by appraisal. A physical demand and a social threat do not produce identical profiles. What survives is the general shape, and the vocabulary. That sustained demand produces a period of successful adaptation with a cost. And that the cost accumulates. That is a substantial contribution, and it is less than the original claim.
Allostasis
Stability Maintained Through Change
Allostasis is the process of maintaining stability through change. Systems adjust their set points to meet anticipated demand, rather than holding a fixed value. It is offered as a more accurate description than homeostasis. Because blood pressure, cortisol, and heart rate are not held constant. They are varied purposefully. Allostatic load is the cumulative physiological cost of repeated or sustained activation. The wear that accumulates when systems are activated too often, or fail to shut off. Four situations are described as producing it. Repeated activation by frequent demands. Failure to habituate to a repeated demand. Failure to terminate a response after the demand has gone. And an inadequate response in one system leading to compensatory over-activity in another. Now the evidential status, which needs stating precisely. The underlying observation is well supported. Sustained activation carries physiological cost. But allostatic load is generally operationalized as a composite index of several measures. And there is no single agreed set of measures, or agreed way of combining them. Which means studies using the term are not always measuring the same thing. So describe it as a productive organizing framework with a measurement problem. Not as an established quantity.
Bodily Systems
Direction Only, and a Caution That Attaches to All of It
Sustained stress is associated with poorer outcomes across several physical systems. These associations are described in direction only. Cardiovascular. Sustained sympathetic activation and repeated blood pressure elevation. Those are associated with cardiovascular difficulty over time. Immune. Sustained cortisol elevation alters immune function. With effects on susceptibility to infection, on wound healing, and on inflammatory processes. Note that the relationship is not simply suppressive. Which is why, stress weakens the immune system, is too crude a summary. Metabolic. Sustained mobilization of stored fuel is associated with changes in glucose handling. And digestive. The suppression of digestive activity during activation. Plus the effects of sustained activation on the gut. Now the caution that attaches to every one of those, and it is not a formality. These are population-level associations, in an established direction. They do not permit attributing any individual's illness to their stress, or to their handling of it. A group-level association tells you nothing about the causes operating in one person. The clinical and ethical stakes here are real. Telling a person their illness was caused by stress is not supported by this evidence. Telling them they would be well if they had managed it better adds blame to illness. It also frequently delays appropriate medical investigation.
Stressor Types
Where the Recovery Goes Missing
Stressors come in several types, and the differences are not only about size. A discrete acute event runs minutes to hours. A near-collision, a difficult interview, an argument. Its signature is sharp activation of the fast pathway, with prompt return to baseline. Sustained strain runs months to years. Caring without support. Insecure housing. An unsafe workplace. Its signature is prolonged activation of the slower pathway, with limited opportunity for recovery. Daily hassles are recurring and brief. Commuting, interruptions, small frictions repeated daily. Repeated low-level activation. Individually trivial, and cumulatively substantial. Anticipatory stress happens before an event, sometimes long before. Awaiting a result. Anticipating a difficult conversation. And its signature is activation in the absence of any present demand. The appraisal alone is sufficient. That row makes the case for the transactional definition better than anything else here. It is a full physiological response to an event that has not happened, and may never happen. No stimulus-based account can explain that. Now the counter-intuitive finding. Chronic low-grade strain frequently outweighs discrete events. A severe acute event produces a large response that resolves. A sustained strain produces a smaller response that does not. And cumulative exposure is the product of intensity and duration. Research on daily hassles has repeatedly found them to predict health outcomes, at least as well as major life events.
In The Clinic
Why Sustained Strain Is Under-Reported
A substantial proportion of people under sustained strain present first with physical complaints. The physiology explains why, and three reasons combine. The symptoms are real, and are generated by real processes. Palpitations, digestive disturbance, muscle tension, and fatigue follow directly from those pathways. Nothing here is imagined. Physical complaints are also more reportable in many settings, and for many people. And the person may simply not have connected them. Someone under sustained strain for two years frequently does not experience it as stress at all. So they will not raise it unless asked. Now, how to ask, because the obvious question fails. People under long-term strain rarely describe themselves as stressed. A situation present for years is experienced as ordinary life. Ask about the shape of a week instead. What the days contain. Who else helps. When the person is not responsible for anything. And when they last had a period free of demand. Ask specifically about recovery. Whether there is any point at which the demand stops matters more than how heavy it is. And ask about control, not only demand. High demand with low control is the combination associated with the worst outcomes. None of this replaces medical assessment where physical symptoms are present. It sits alongside it. One more source of variation. The same demand met with support, money, and control is a different demand.
Emotions
Four Components That Can Come Apart
An emotion is a coordinated change across several components. Occurring in response to something appraised as significant. Defining it by the components rather than by the feeling is deliberate. The feeling is one part of an emotion, rather than the whole of it. There are four components. Take fear as the worked example. The physiological component is changes in bodily state, driven by the pathways we just covered. Heart rate rises, breathing quickens, muscles tense. It is measured by heart rate, skin conductance, or hormonal assay. The experiential component is the subjective feeling. What it is like from inside. It is measured by self-report, which is the only direct access, and carries the limits of self-report. The expressive component is changes in face, voice, and posture, visible to others. Widened eyes, raised voice, drawn-back posture. And the behavioral component is the action tendency. What the emotion prepares the person to do. The impulse to withdraw, freeze, or escape. Now read across that row and notice something important. The four components can dissociate. A person may show the physiological and behavioral components while reporting no feeling. Or report a feeling with very little bodily change. That is why measuring emotion is difficult. And it is why the theories in thirteen point two disagree with each other. They disagree about which component comes first.
Functions
Solutions, Not Interference
Emotions are frequently discussed as though they were interference with clear thinking. The functional account holds the opposite. They are organized solutions to recurring problems, and four functions are standardly identified. Action preparation. Each emotion has an action tendency, and the bodily state that supports it. Fear with escape. Anger with confrontation. Disgust with rejection and expulsion. Communication. Emotional expression signals internal state to others rapidly. And without deliberate encoding, which coordinates behavior between people faster than speech can. Social coordination. Emotions regulate relationships. Guilt and shame respond to transgression. Gratitude and affection maintain cooperation. These operate as a system across people, rather than within one person. And guidance of judgment and memory. Emotional significance influences what is attended to, what is remembered, and how decisions are weighted. A decision made with no emotional input is not thereby a better decision. That finding surprised the field when it emerged. Three terms get used interchangeably in ordinary speech, and are separated here. An emotion is brief, relatively intense, and has an object. It is about something. A mood is longer-lasting, generally less intense, and has no particular object. A person is in a low mood, rather than low about something. Which is what makes chapter twelve a chapter about mood rather than about emotion. Affect is the broadest term, covering the whole domain. Clinically it means the emotional state observable to another person.
Adaptive Value
No Emotion Is Inherently Pathological
Four emotions frequently described as negative persist, because each solves a problem. And each becomes clinically relevant in the same three ways. Through intensity, through duration, or through mismatch with the context. Fear prepares for escape from danger. It becomes problematic when disproportionate to actual danger, or when it persists after danger passes. Or when it is triggered by things that are not dangerous. That is chapter eleven. Anger prepares for removal of an obstacle, or correction of a transgression. It becomes problematic when disproportionate, sustained, or triggered by misread intent. Sadness follows loss. It slows activity, and it signals need to others, which elicits support. It becomes problematic in the sustained, pervasive form described in twelve point one. Disgust protects against contamination. Extended socially, it protects against association with what a group treats as impure. It becomes problematic when directed at people, which connects to the stigma material. Now the general principle, because it governs this whole chapter. No emotion is inherently pathological. The aim of treatment is never the elimination of an emotion. What is treated is intensity out of proportion, or duration out of keeping. Or a mismatch between the emotion and the situation that produced it. One term to carry forward. Emotion regulation. The processes by which people influence which emotions they have, and when. And how they experience and express them. Two points about it belong here. Regulation is continuous and largely automatic, rather than an occasional deliberate activity. And difficulties in it appear across a wide range of the conditions in this course.
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