The Stress History

Negative life events that persist for more than a short time sometimes can cause physical symptoms.  We can divide the wide range of issues that can do this into five major categories, which simplifies the diagnostic process considerably.  In evaluating medically unexplained symptoms, I inquire into each category in a process called taking the Stress History.  I do this after having acquired a clear chronology of the patient’s illness.  I know when and where symptoms began and their pattern over time.  This often enables me to find links between symptoms and stresses.  For example, I often ask if anything stressful occurred just prior to the onset of the illness.  When I find these connections in timing, it increases the likelihood that the stress is responsible for the symptom.

Here are the five parts of the Stress History:

1. Current Stress.  Is the person coping with a personal crisis, marital problems, family difficulty or workplace issues?  Are they the kind of person who cares for everyone else in their world but never gets around to caring for themselves?

2. Prolonged Effects of Childhood Stress.  Would the person not want their own child to grow up they way they did?  Did they suffer long-term harm to their self-esteem?  Did they suffer abuse or neglect?  Was there violence or drug/alcohol abuse in the home?

3. Depression.  Many people with this disease do not feel particularly depressed.  An excellent review of the full range of symptoms can be found here: National Institute of Mental Health Depression Page

4. Post-Traumatic Stress Disorder.  Has the person ever experienced a horrifying or terrifying event, even if it was many years before their illness began?  An excellent review of PTSD can be found here: National Institute of Mental Health PTSD Page

5. Anxiety Disorders.  Many people with anxiety disorders experience the majority of their symptoms physically.  An excellent review of this condition can be found here: National Institute of Mental Health Anxiety Disorders Page

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