Stress is a normal part of life. Many happenings in our lives and many things that we do, require us to make a change or adjustment. The body reacts to these changes with physical, mental, and emotional responses. Stress can be positive, keeping us alert and active to achieve goals. This is eustress. Stress becomes ‘distress’ when a person faces difficult situations continuously.

Mr. John, a 40 years old executive in a reputed Kuwaiti company, came to consult me (NZ) because his diabetes was not under control even with the maximum dose of oral medicines and his doctor advised Insulin injections. He admitted that he was under a lot of stress at work. A MINI neuropsychiatric interview scored high for depression and anxiety. He was advised stress relieving measures and a safe, non sedating and non habit forming medicine. Within a few weeks his diabetes came under good control and he was able to perform better at work, home and social life. He did not require insulin and is in the process of reducing his medicines. He is just an example of the many with diseases like diabetes, high blood pressure, heart disease, asthma, peptic ulcer and headache whose illness is made worse by stress.

Stress can be experienced in different circumstances. Sometimes the cause of stress is immediate and often following an event like death of a relative. A difficult marriage or work situation can lead to chronic distress.
The cause of stress is not always external. When suffering with a physical or psychological illness, a person many feel stressed.

Not all causes for stress are negative, even the success in our lives can increase stress like a promotion or a transfer.

Each individual may have different reactions to the same stressful event.

Many people experience a mixture of psychological and physical symptoms. This can lead to disorders, such as:
• Raised blood pressure, palpitations, chest pains
• Abdominal pain, peptic ulcer, bowel disorders, “gas”, indigestion.
• Muscular strain, backache , arthritis, general aches and pains
• Changes in the hormonal levels leading to menstrual disorders etc.
• Weight gain or loss of weight.
• Diabetes and related complications
• Psychological illness such as depression, anxiety, panic attacks.
• Skin problems like pimples, repeated or prolonged allergies
• Breathing problems like wheezing , continuous cough
• Sleep problems
• Cold and sweaty palms
• Tiredness, exhaustion
• Trembling and shaking
• Dizziness and headaches
• Weakening of the immune system leading to repeated infections or even certain cancers

Studies show that over 75% of the outpatients have diseases caused or made worse by stress.

What makes us prone to stress?
Stress is not due to a single reason but often a combination of factors.
Hereditary : Those who are prone to experiencing stress often have family members who also suffer from stress.
Home situation : difficult living conditions, loss of a parent in child hood, physical and or emotional abuse.
Personality : Some people are more prone to feeling stressed than others. Attitudes that cause more stress are.
Perfectionism - constant pressure to achieve, criticising oneself when not perfect, never satisfied with what we have done
People pleasing – care for others than self, doing things only to please others, worried over disappointing others
Need for Control – want to be in perfect control at all times, view mistakes as signs of weakness, uncomfortable with delegating work
Competence – low confidence, undermining self, not happy when appreciated, low self-esteem.
Cultural: social expectations one finds difficult to fulfill can cause distress
Gender: Women are more prone to stress during their monthly periods, childbirth and menopause. .Also in many cultures there are more demands or restrictions placed on women. Working women have more stress in managing both career and home efficiently.
Men experience stress to achieve more and provide well for their families for which they may need to spend extra time and sharpen their skills.


How do I know if I am stressed?

Some of the common indicators of increased stress are:
Experiencing difficulty or change in any aspect of life –home, work or health.
Increased worry, anger, periods of boredom.
Increased sensitivity to criticism and decreased motivation
Inability to concentrate, forgetfulness.
Difficulty with sleep.
Sexual difficulties including inability to perform, lack of interest and pleasure Initiating or excessive consumption of cigarettes, coffee, tea, alcohol or drugs
Illnesses with no specific cause or that recur for no particular reason.


How can we prevent and relieve stress?

Major life events are usually not the main cause of stress; most of human stressors are caused by day-to-day event.

Life style to follow
Work regular hours and take adequate breaks and holidays.
Sleep and rest are nature’s own stress relievers .A sleep deprived person is less able to face the stress of routine life.
Eat healthy, well-balanced meals.
Avoid cigarettes, alcohol and stimulants.
Engage in activities that one enjoys like listening to music, reading, socialising.
Practise stress relieving measures - regular exercise, yoga, meditation and prayer, fellowships help many to feel less stressed.

Attitudes that decrease stress.
Keep a positive attitude.
It is necessary to know one’s own abilities and limitations. One who prefers to work by himself may excel as a researcher and not as a personnel manager.
One must acknowledge that some events are beyond our control or ability to change.
Do not avoid thinking about difficult events or feelings; they never go away until resolved. If ignored, the distress intensifies or appears in another form such as an illness.
Be assertive instead of aggressive. Assert our feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
Enhance skills of management of time, decision-making, career planning. Delegate responsibilities instead of trying to manage everything oneself.
Build relationships with those who share professional or homemaking interests. Confide difficulties to them and they could encourage or point out areas for improvement.

Conclusion
Stress and distress are part of our lives. Often it helps us to plan and prepare better at home or work. However excess stress can be very damaging to our physical and emotional lives. Life style and attitude change are often sufficient.
Combating negative thoughts and replacing them with positive ones takes practice, but the results are worth it.

When the stress experienced is not fully relieved in spite of all efforts, it is time to seek professional help. A psychiatrist is the best person to consult. If psychiatric help is not available, an enlightened family physician or GP can help.
Safe and non habit forming medicines are available to relieve depression and anxiety. These should be used without hesitation if the doctor advises.

Dr. Noble Zachariah
ACFMS, Jahra

Dr. Daisy Noble
German Medical Care
Jleeb Al Shouyuk