Each of us experiences stress in our everyday lives, whether in the work or family environment or in our relationships. This is experienced as a feeling of fear or apprehension, accompanied by tightness in the chest and physical symptoms such as sweating, trembling, and a fast heart. It is often caused by some change in our lives over which we feel we have no control. It could be a new date, exam results, or a fight. It could also be something more serious—a serious accident, an illness, or the death of a loved one. It can last for weeks, even months.
For most people, the stress goes away when the problem is solved. Sometimes just the passage of time helps. For some people, however, the stress remains and becomes much greater—even more overwhelming—and completely out of proportion to the situation. These people suffer from some kind of stress disorder. However, they can perform normal, everyday activities and be functional.
Acute stress disorders are the result of irrational beliefs about the dangers of certain situations or events. Research has shown that people with stress disorders overestimate the dangers of various situations. These last for at least six months and can get worse if left untreated. Usually, these disorders coexist with other disorders, including alcohol or drug use, which can mask the stress symptoms or make them worse.
There are six different types of acute stress disorders. Each stress disorder has different symptoms, but all types have one thing in common: uncontrolled and irrational fear prevails.
1. Panic disorders
Panic disorders are characterized by the onset of sudden attacks of stress and intense fear, usually accompanied by physical symptoms, such as sweating, rapid heart rate, weakness, or dizziness. During the attack, people feel very shaky or numb, and may also have nausea or chest pain. People with panic disorder avoid events or situations because they are afraid of another crisis occurring. They cannot predict when or where the crisis will occur, and this creates more fear and stress for them.
A seizure can happen anywhere, anytime, even at bedtime. Usually, an attack lasts about 10 minutes, but some symptoms last longer. Panic attacks are often associated with reduced quality of life and disturbed psychosocial functioning.
The earlier someone turns to a specialist, the better the prognosis for recovery. Cognitive behavioral therapy is a structured and usually short treatment, between 10 and 20 sessions. There are clear goals to be achieved. It aims to correct destructive thoughts and fears of bodily sensations. This treatment can be started at the same time as medication and uses the following means and techniques: psychoeducation, stress management techniques (muscle relaxation and correct abdominal or diaphragmatic breathing), cognitive restructuring, and gradual exposure to events, situations, or places associated with the panic attacks.
The results of a study with 76 patients with panic disorder have shown that the combination of cognitive (psychoeducation, cognitive restructuring, problem-solving techniques) and behavioral techniques (exposure) has significant effectiveness in improving acute symptom remission and maintaining good outcomes for up to 6 months after cognitive-behavioral therapy.
2. Obsessive-compulsive disorder
Obsessive-compulsive disorder is characterized by a cycle of obsessions and compulsions that cause intense distress, dysfunction, and fear. Obsessions are involuntary, repetitive, and unwanted thoughts that cause feelings of stress or fear. Compulsive, repetitive behaviors are a result of obsessions. Performing rituals provides temporary relief from the stress created by obsessions. Often, people’s need to perform compulsive behaviors grows stronger over time.
If the initial behavior becomes less effective in reducing stress, then other behaviors or more elaborate rituals are added to provide relief. Compulsive behaviors can become extremely time-consuming and affect normal functioning.
Some of the common obsessions in OCD include:
- Fear of germs or diseases.
- Use of household chemicals.
- Concern for accuracy and detail.
- The fear of being responsible for something terrible happening.
- Forbidden or perverted sexual thoughts or images.
- Forbidden or perverted sexual urges for others.
- Obsessions about homosexuality.
- Sexual obsessions involving children.
Some common compulsions include the following:
- Washing hands too many times or in a certain way.
- Excessive showering, bathing, brushing teeth, or grooming.
- Checking that nothing terrible has happened.
- Checking that no error has occurred.
- Prayer for the prevention of harm.
- Avoiding situations that could trigger obsessions.
The best treatment for most people with OCD should include one or more of the following four things:
- An intervention called Exposure Response and Prevention (cognitive-behavioral therapy).
- An appropriately trained behavioral therapist.
- Sometimes there is also medication.
- Support of the family and the environment.
Most studies show that, on average, about 70% of OCD patients will benefit from appropriate medication or cognitive behavioral therapy (CBT). Patients who respond to medication typically show a 40 to 60% reduction in OCD symptoms, while those who respond to cognitive-behavioral therapy often report a 60 to 80% reduction in symptoms. However, medications must be taken on a regular basis, and patients must actively participate in psychotherapy.
Unfortunately, studies show that at least 25% of OCD patients refuse the cognitive-behavioral approach, and 50% of OCD patients stop medication because of side effects or for other reasons.
3. Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) usually develops after a frightening experience involving physical harm or a physical threat. The person who develops PTSD may have been harmed, or the harm may have happened to a loved one, or they may have witnessed a harmful event happen to loved ones or strangers.
PTSD can result from a variety of traumatic events, such as robbery, rape, torture, captivity, child abuse, car accidents, shipwrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.
People with PTSD can startle easily, become emotionally numb, lose interest in things, have difficulty feeling affection, be irritable, be more aggressive, or even be violent. They avoid situations that remind them of the original incident, and “anniversaries” of the incident are often very difficult.
Post-traumatic stress symptoms are worse if the event that caused them was deliberately initiated by another person, such as a robbery or kidnapping. Most people with PTSD relive the trauma repeatedly in their thoughts during the day and in nightmares when they sleep. This is called looking back. Flashbacks can consist of images, sounds, smells, or feelings, and are often triggered by ordinary events, such as a knock on the door. With a flashback, the person may lose touch with reality and believe that the traumatic event is happening again.
Symptoms usually begin within 3 months of the event, but sometimes appear several years later. They must last longer than a month to be considered PTSD. The course of the disease varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
Certain types of medication and certain types of psychotherapy usually reduce PTSD symptoms very effectively.
4. Social phobia (or social stress disorder)
Social phobia is a stress disorder that can be described as a strong feeling of fear in situations of humiliation or embarrassment. Patients usually fear performance or interaction situations such as public speaking, eating and drinking in public, using a public toilet, entering a crowded room, talking on the phone, etc. Finding a partner or spouse is often difficult for people with social phobia, and sex may be almost impossible, as can even eye contact.
Experts have devised a specialized cognitive therapy for social phobia that aims to reverse the processes predicted in the model. Since the model emphasizes self-focus, negative self-processing, insecurity, and behaviors, the therapy also emphasizes ways of reframing thought processing that maximize negative beliefs.
5. Specific phobias
A specific phobia is an intense, irrational fear of something that actually poses little or no threat. Some of the most common phobias are intense fears of heights, escalators, tunnels, highway driving, closed spaces, dogs, spiders, and blood.
People with specific phobias may be able to ski the world’s highest mountains with ease, but find it difficult to climb above the fifth floor of a building. While adults with phobias realize that these fears are irrational, they often find that they cannot deal with them, which causes panic or stress attacks.
Specific phobias are twice as common in women as in men. They usually appear in childhood or adolescence and tend to persist into adulthood. The causes of specific phobias are not fully understood, but there is some evidence that there is a genetic predisposition.
If the fear is easy to avoid, people with specific phobias do not seek help. But if avoidance interferes with their career or personal life, treatment is usually sought, and deactivation is possible.
People with specific phobias respond very well to carefully targeted and structured behavioral psychotherapies.
6. Generalized Stress Disorder
People with generalized stress disorder spend the day filled with excessive worry and tension, even if there is nothing to cause it. They expect disaster and worry too much about health issues, money, family problems, or difficulties at work. Sometimes just thinking about it during the day produces stress.
Generalized stress disorder is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with generalized stress disorder can’t seem to get rid of their worries, even though they usually realize that their worry is more intense than a real situation. These people can’t relax, startle easily, and have difficulty concentrating. They often have trouble sleeping or staying asleep.
Physical symptoms that often accompany stress include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, tremors, twitching, irritability, sweating, nausea, dizziness, frequent trips to the bathroom, and hot flashes.
When their stress level is mild, people with generalized stress disorder can function socially and cope with everyday life. However, sometimes, as a result of their disorder, people with generalized stress disorder may have difficulty performing daily activities if their stress is severe.
The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. There is evidence that genes play a small role in the onset of the disorder.
Generalized stress disorder is treated with cognitive-behavioral therapy. Medication can help in phases when stress causes a very significant problem in functioning, but chronic treatment with anxiolytic drugs carries a great risk of causing dependence on these treatments and worsening the condition.