Read Excerpt: 'So Stressed' Stephanie McClellan, Beth Hamilton

"So Stressed" by Stephanie McClellan and Beth HamiltonCourtesy Free Press
"So Stressed" by Stephanie McClellan and Beth Hamilton

"So Stressed," by Stephanie McClellan and Beth Hamilton, examines the consequences of stress on women.

The authors, both doctors, chronicle the symptoms, from hair loss to dull skin to looking older than you are, and identify ways to help you regain control and reduce stress.

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VIDEO: Dealing With Stress for WomenPlay


Sally, a twenty-five-year-old mother of a young son, sat rigidly on the examining table, looking thin and frail. Her eyes were puffy,her skin dull. She had made an appointment to see Stephanie again because her vaginal pain and discharge, which had been occurring for several months, had not responded to various treatments. She was terrified, convinced that she had terminal cancer.

Her examination revealed swelling and redness. Under the microscope, the sample showed huge numbers of inflammatory cells without obvious offending bacteria or yeast. Sally fit a diagnosis of desquamitive inflammatory vaginitis, which stems from an overactive immune system. Her immune system was attacking the cells of her vagina as if they were foreign, leading to outright pain, excessive vaginal secretions, and difficulty having intercourse. Sally did not appear relieved when Stephanie assured her that there was a treatment that would probably resolve her condition completely. Still convinced that she had a serious illness, she felt miserable and had been getting worse.

Our clinical experience at OC Gyn has shown that this is a stress related condition, but Sally had not made a connection between any stress she was experiencing and her persistent physical problem. When Stephanie asked Sally directly if she was experiencing more stress than usual, Sally cracked and began to cry. She confided that her son was defiant and extremely demanding. Her husband worked long hours in hopes of moving up at his job and was never home. She had no help, because her husband felt it was an unnecessary expense and they were saving for a new home with room for more children. No family members lived nearby to give her a hand; she had to do it all alone and felt isolated. By the time her husband came home, she was exhausted and irritable. She didn't mean to be difficult, especially since he was working so hard, but all they seemed to do was bicker.

Sally's stress had been so bottled up within her that she simply couldn't stop crying now that she was admitting how hard things were for her. Stephanie listened, let her vent, and consoled her as best she could. When Sally calmed down, they discussed a treatment plan for her vaginal condition, and Stephanie explained that she would not get better until she addressed her stress level. Stephanie explained how important it was, not so much because Sally was physically uncomfortable but because the stress was clearly affecting her immune function and could lead to more serious health consequences. Stephanie suggested that Sally seek professional therapy and also find some time for herself.

At Sally's return visit a few weeks later, her physical condition had improved, because she had been compliant about taking her medication, but she had not made any changes to affect the quality of her life. She broke down crying again, still convinced that she had a lifethreatening illness. Stephanie explained once more that the seriousness of her condition involved her inordinate stress and advised Sally that unless she did something to relieve her stress, she really could develop a life-threatening condition.

At her next visit, a month later, Sally smiled when Stephanie walked into the room—things obviously had changed. She was full of energy. Her skin was bright and smooth, her hair brushed and groomed. The symptoms that had brought her to the office initially were gone. Sally had talked with her husband about Stephanie's advice for reducing her extreme stress levels, and he had agreed to hire a babysitter a few times a week to give her some relief. She was taking a spin class and had joined a mothers' group at the community center. She was back to being her vivacious self.

Susan, thirty-two, is all too aware of how stress is affecting her, because her chronic bladder infections tend to flare up when she is under stress. During her last visit to our offices, she talked to Beth about the correlation between the infections and the amount of pressure in her life. She had a lot going on: she had been caring for her mother, who was recovering from a mastectomy; she had a new man in her life; and she had moved her household. That's three of life's major stressors. She had been so busy with her mother that she hadn't even had time to unpack and settle into her new place and was still living out of cartons. Stress can impair your immune system, which makes it hard for the body to fight off infections. Since Beth had treated Susan for other chronic urinary-tract infections, she suggested that Susan change her diet to incorporate probiotics, which are dietary supplements or foods that resemble the beneficial microorganisms found in your digestive system. Then, Beth made recommendations about how Susan could reduce her stress; Beth encouraged her to take the time to unpack and settle into her new home, and, with Susan's input, designed a program of exercise and nutrition. She also advised her to take breaks and listen to music whenever dealing with her mother's illness became overwhelming. Susan was happy to know that she had been correct about the root of her problem and was motivated to make these changes in her life to improve her health.

Stress looks different on different people. Your reaction to stress is multifaceted and is shaped by your psychology, physiology, genetic makeup, and environment. Every woman's response to stress is unique, so it stands to reason that each woman requires individual ways to manage her stress.

Factors That Shape a Stress Response
Health status
Type of stressor
Duration of exposure
Early childhood experience
Nutritional status
Alcohol, drugs, some medications
Social support

In our practice, we have become so sensitive to the consequences of stress that we recognize a wide range of telltale signs that indicate a patient is having difficulty coping with the pressures in her life. Women who are affected by stress can be thin or obese. Their posture can be rigid or slumped. They can be vigilant and anxious or subdued and passive. Many are tremulous. As we describe the many other manifestations of stress, you will recognize some of these traits in yourself.

Our patients have varied complaints, but we hear a handful repeatedly: hair loss, losing skin tone, not seeing results from exercise routines, and accumulation of fat around the middle. All these physical changes are a direct result of chronic stress.

Your skin, the largest organ of your body, reflects your physical and mental health fairly directly. Stress causes eczema, hives, rosacea, psoriasis, alopecia, and vitiligo. There is also a correlation between stress and acne. In fact, there is such a strong connection between the brain and the skin that scientists have named a field of study "psychodermatology." When stress disturbs the body's homeostasis, or balance, your hormones can malfunction, impairing the rejuvenation of your skin. Skin is always in a process of renewal, which takes twenty-eight days when you are young but slows down as you age. Emotional stress retards cell renewal, destroys collagen fibers in the skin, and breaks down elastin. This means sags and wrinkles. Evidence also suggests that stress causes the barrier protection of the skin to break down, affecting skin hydration and its normal immune function. This breakdown is part of the reason why we often get sick during times of stress.

Unrelenting stress may result in the thinning and dulling of your hair. Many of our patients who are under chronic stress complain of hair loss. They are troubled by the amount of hair they find in the shower after they wash their hair. Fortunately, stress-related hair thinning will often stop when your stress is resolved or when you learn how to manage it.

In extreme cases, stress can cause significant hair loss in two different ways. It can cause hair to stop growing, a condition called telogen effluvium; this is when some hair follicles go into a resting phase and fall out two to three months later. Usually, the hair grows back within six to nine months. The second condition is known as alopecia, a more inflammatory response. With this condition, hair follicles are attacked by immune cells. This leads to hair loss in patches or on the entire scalp. Alleviating your stress will help these conditions, too.

Stress can actually speed up the aging process by harming DNA. Elissa Epel, a psychologist, and Elizabeth Blackburn, a Nobel laureate in cellular biology, discovered this in a landmark research study at the University of California at San Francisco. The study compared thirtynine healthy mothers who care for a chronically ill child with nineteen women raising a healthy child. They chose to work with mothers of young children because mothers experience chronic stress at a young age; full-time caregivers tend to have little time for themselves and make huge personal sacrifices.

The study had two levels of assessment: physiological and psychological. With a blood test of white cells, they were able to measure damage to DNA, specifically the most fragile part of the chromosome, called the telomere. The protective caps at the ends of telomeres carry genetic information. The telomeres are instrumental in determining the health and life span of cells. Dr. Blackburn compares them to the tips of shoelaces: if you lose the tips of your shoelaces, they start to fray. The telomeres protect DNA and promote genetic stability in the same way, by preventing the DNA strands from unraveling.

The enzyme telomerase restores the length of the telomeres when they get worn and replenishes a portion of the telomeres, allowing the cell to repair itself. As we get older, telomerase production lessens, and consequently our bodies age. As more cells die, the visible effects of aging—diminished eyesight and hearing, wrinkled skin, and loss of muscle—become apparent.

The findings of this study show that the longer the mothers had been caring for their chronically ill child, the lower their telomeraserepair activity and the worse the state of their DNA. The cells of the high-stress women appeared to be nine to seventeen years older than the cells of the lower-stressed women.

In the psychological assessment, the mothers took a written test to measure their perception of the intensity of stress in their lives. Again, the study found that those women with higher perceived stress had greater cell aging. Both groups of mothers showed the same relationship between perceived stress and damaged DNA, but the mothers who coped well under stress, as their psychological assessments revealed, who didn't let it get to them, did not suffer the same level of damage to their telomeres.

Though the stress-and-aging study proved that the perception of stress can affect your body on a cellular level, you may not be aware of these effects, or you may have symptoms without a physiological cause. We call this the mind-body disconnect—when a patient has a stress-related disorder even though she does not report feeling stressed or feels that stress is making her sick when there is no evidence of illness in her body.

The mind-body disconnect, also known as "missing covariance," complicates the diagnosis and management of chronic stress. The external signs of stress can appear different from person to person, so try to be aware of any changes in the way you feel and behave. Stress can creep up on you so that you start making accommodations for it—you stop going to the gym as often because of work deadlines; you start drinking more coffee during the day and a couple of glasses of wine in the evening because you can't get to sleep and don't wake up refreshed; you grab fast food instead of a salad between appointments for yourself or your kids. Soon your stress has mounted and become so unrelenting that it takes a profound toll on your body, unless you take steps to defuse your physical and mental response to it. We will help you develop your awareness of when stress is wearing you down and how your body lets you know that's happening with symptoms such as changes in your skin, hair, weight, and mood. We'll give you the tools to stop the destructive effects before your health is damaged.

This following list of symptoms is not complete, but it should give you an idea of the kinds of signs you should look for.

The Warning Signs and Symptoms of High Stress
Nervousness or anxiety
Sadness or depression
Sleep disorders
Lack of interest, motivation, or energy
Inability to concentrate
Muscle tension, especially in the neck and shoulders
Upset stomach, bloating, appetite changes
Dizziness or faintness
Tightness in chest
Reduced sexual desire
Skin problems such as rashes, acne, or hives
Aches and pain
Menstrual irregularity
Constipation or diarrhea
Hair loss or dullness

If you've ever had any of these symptoms, consider starting a journal. If you have any of these symptoms regularly, make a note of that as well. If you can link them to events or pressures in your life, like deadlines at work or disagreements with your partner or spouse, note that, too. Observing how you feel and behave when you are stressed will help you to identify your stress type, which we will discuss in chapter 4, "Identify Your Type: The Four Stress-Response Patterns."

The Consequences of Long-term Stress for Women
Women are more likely than men to report stress (51 percent as opposed to 43 percent, respectively) and report a wider range of stressors, including time constraints, the expectations of others, marital relationships, children, and family health.
Women are 2.7 times more likely than men to develop autoimmune diseases, which are a direct result of stress, including type 1 diabetes, multiple sclerosis, lupus, rheumatoid arthritis, thyroid disorders, and inflammatory bowel disease. Stress-induced heart disease is the number-one killer of women, but only 13 percent of women consider heart disease a health threat.
Sixty-four percent of women who die suddenly of heart disease had no previous symptoms.
Stroke kills more women than men; women represent 61 percent of stroke deaths.
Nearly one-third of women ages eighteen to fifty-nine suffer from a loss of interest in sex.
Women have a higher prevalence of pain than men and suffer more musculoskeletal pain than men in older age.
Stressful events, including loss of a loved one, are linked to an increase of breast cancer in women within two years of the event.
Women with a diagnosis of breast cancer who consider themselves highly stressed are more likely to have a recurrence.

Chronic stress will make you sick. The good news is that you can manage and even change your response to the pressures in your life. When you do, you will look better, feel better, slow the aging process, and lower your risk for disease.

The next chapter will give you an understanding of how your thoughts, emotions, and perceptions shape your stress response.

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