FIGURE 4-2 How chronic stress can affect behavior and health. All people have some pre-existing load of stressful experiences reflected in brain and body. Chronic life stressors (such as interpersonal conflicts, care-giving, pressure at work, and crowded and noisy living and working conditions) can affect people by creating a sense of chaos, conflict, and a lack of control. The result of the chronic stressors will often be chronic anxiety and depressed mood with poor-quality sleep. Anxiety, mood changes, and inadequate sleep can lead to self-medication through eating “comfort foods,” excessive alcohol drinking, smoking, and neglecting regular exercise. Together with the anxiety, depressed mood, and poor sleep, these behaviors dysregulate the normal physiological activities and create a chronic stress burden (allostatic overload). The dysregulated stress response involves increased cortisol, insulin, and inflammatory cytokines at night; along with increased heart rate and blood pressure; and reduced parasympathetic tone. If this abnormal dysregulated state persists for months and years, there are likely to be adverse health outcomes, such as hypertension, coronary heart disease, stroke, obesity, diabetes, arthritis, major depression, gastrointestinal disorders, chronic pain, and chronic fatigue.

depression, and such health-damaging behaviors as overeating (Dallman et al. 2003), smoking, and excessive drinking (Anda et al. 1990; Dube et al. 2002). Those behaviors, in turn, increase and dysregulate the body’s mediators normally involved in allostasis. When one mediator, such

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