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Stress affects different people in different ways. Some people experience mainly behavioural or emotional effects, while others experience primarily somatic symptoms, such as skin disturbances, menstrual disruption, loss of libido, anxiety or palpitations, and sleep disturbances.

Cognitive symptoms of stress are a feeling of being “stretched” to capacity, irritability and difficulty in attending to or concentrating on things, poor memory (as a result) and a change in social behaviour (greater need for or avoidance of affiliation).

Emotional aspects of stress symptoms include a feeling of anxiety or nervousness, tremulousness, panic attacks, feeling of depression or emotional exhaustion, lack of patience or anger.

Behaviourally, there may be increased irritability, increased errors or decline in performance on daily tasks, such as at work. The stressed person may become withdrawn and unwilling to interact with others, in an attempt to minimize non-essential demands. They may become less tolerant of mistakes, inefficiencies or demands from others, including family members. Their normal pattern of behaviour may change, and they may become increasingly unpredictable in their behaviour (look at the mpg web page on the slide for an amusing example of what might happen!).

Physiologically, almost every system can be affected by stress. Most commonly symptoms manifest in the form of cvs, (palpitations, tachycardia or ectopics, changes in BP), GI, (stomach upset, indigestion or gas, ulcers, changes in appetite, diarrhoea, and possibly also irritable bowel, colitis and other lower GI disturbances), GU (menstrual disturbances, impotence, premature ejaculation, orgasmic dysfunction), and dermatological (eczema, acne, utricaria, possibly Lichen Planus), and immunological (increased vulnerability to infection, delayed wound healing, possibly rheumatoid and other inflammatory joint conditions, as well as immunological-mediated conditions in other systems listed above. Some research has tried to link stress to cancer onset, however, the evidence remains controversial). Most of these changes are likely mediated by changes in hormonal activity.

Many patients presenting with these kinds of problems in clinics will have underlying stress. The problem is differentiating stress pre-dating from that arising as a consequence of the illness or disease.