What is stress and how does it manifest itself?
Stress is defined is “a state of psychological strain or pressure due to a adverse or demanding situation.” The stressful event is usually a bad one like a divorce, financial stress or death of a loved one, but it can also be a good event like a job promotion, marriage or having a child which can put pressure and cause stress to us.
Moreover, it can be just an internal thoughts about something stressful like interpersonal relationship difficulties or external like being in a stressful situation at work.
It can be real or hypothetical. It does not matter what kind of stress one faces, what matters most is how our mind and body respond to it and how we cope with it over all.
Nature of the stressor and its importance to the person is important as not every stressor has same impact for every one. While one might take job promotion in stride and deals with initial challenges of it with some difficulty another person may struggle to overcome the same kind of challenges, becoming psychologically overwhelmed and it may impact their physical wellbeing.
Chronicity of the stressor can overwhelm a person’s adaptive level of responding to stress adequately. Constantly challenging our neuro-endocrine-immune response system to cope with stress, resulting in constant activation and ultimately failure of the stress response system.
Three major groups of stress symptoms:
Symptoms of stress can be physical, psychological and behavioural and manifest itself in different way.
Physical symptoms: tiredness, having sleepless nights, not feeling hungry, change in appetite, headaches, physical exhaustion, fatigue, weight gain/loss, digestive problems, various levels of dysregulation ranging from immunosuppression to inflammation and as a result skin problems. Skin is very well connected with the neuro-endocrine-immune system and plays a fundamental role in maintaining balance (homeostasis) when faced with stress.
Psychological symptoms: rigidity to change; cynicism, low morale, frustration, depression, increased worry, apathy, emotional exhaustion, loss of emotional control, boredom, guilt failure feelings, alienation, under/over-confidence, feeling anxious or irritable, mood changes, changes in how you interact with colleagues, too much emotion, feeling isolated or socially withdrawn.
Behavioural symptoms: Low job performance/job satisfaction, decreased communication, social withdrawal, accident proneness, forgetfulness, poor concentration, irritability, being critical, increased absenteeism, lack of job focus, nail biting, grinding teeth, defensiveness, lack of self care, struggling with workload, low levels of concentration and focus, difficulty in organising, low productivity, negative attitude, changes in motivation.
Moreover, since we are talking about skin stress connection there are different behavioural symptoms related to out body and skin in particular, drinking less water, poor nutrition, taking less care of our skin, due to forgetfulness we might fail to use creams and serums regularly etc.
What is the link between our skin and psychology? What is the link between
our skin and stress?
The skin has long been recognised as the ‘organ of expression’ and serves as the boundary between ourselves and the outside world, a ‘first point of contact’ when strangers meet us. It is also the largest organ of the body.
The ways in which the skin can react to many different stimuli, both physiological (i.e. a rash caused by an external noxious substance) and psychological (an individual may blush when feeling embarrassed) moreover, fear, anxiety and shame as well as sexual pleasure and excitement can be indicated visibly by growing pale, blushing or hair rising which highlight the complexity of the relationship between the skin, and external and internal factors.
It has been estimated that between 40% and 80% of patients attending a dermatological clinic have experienced significant psychological problems.
Thus the connection between skin – stress and psychology in general can go
According to Koblenzer a classification system comprising three specific, main categories:
• Skin issues due to psychiatric disease.
• The effect of psychosocial stress on skin.
• The somatopsychic effect.
Another classification by Cotterill comprised of five more detailed classifications:
• Individuals who experience psychosocial morbidity such as depression as a result of their skin disease. Visibility is considered to play a particular role in this group and it is not uncommon for these feelings to develop towards suicidal ideation.
• Patients who developed some type of skin disease as a result of exposure to excessive stress or strain.
• Patients which present with factitious disorders such as dermatitis artefact, trichotillomania. It could be a form of emotional release in situations of distress or part of an attention seeking behaviour.
• Some patients suffer dermatological delusional disease in which the
commonest psychiatric assessment reveals depression. Patients present with some physical complaint relating to the skin or hair and delusions of parasitosis, the most common of these conditions is actually very rare. These patients are generally regarded to have hypochondriacal psychosis.
• Finally, there is a group of patients who may develop dermatological disorders as a result of pharmaceutical therapy and the induction of acne and
psoriasis in susceptible individuals which affect people’s psychological state. Skin diseases are more often accompanied by changes in the person’s physical
appearance and these changes are often obvious to others. This generates two major consequences.
• Firstly, the visibility of the condition may well be noticeable to others and draw people’s attention. This can remove the feeling of personal control from the sufferer, as they no longer control when and how others know about their disease.
It can often feel like their condition becomes ‘public property’ whereas many
non-visible, internal diseases allow the sufferer to control who knows about their condition and when.
• Secondly, skin disease has often been associated with myths surrounding lack of hygiene and contagion. This can influence others to act negatively towards the sufferer and hence often generate feelings of profound stigma.
The fact that skin disease can often be progressive and episodic means that sufferers can sometime feel that they constantly have to adapt to the changes in their physical appearance.
It is often found that patients begin to feel handicapped and avoid social situations where their skin disease can be viewed by others and they can tend to have a poorer body image and lower self-esteem than the general population.
The episodic nature of many skin conditions also affects the way that
patients conceptualise the cause of their condition. Uncertain aetiology combined with oscillating severity can cause sufferers to generate their own reasoning for their periods of exacerbation.
This can lead to the avoidance of behaviours, places and events that may have no actual significance as regards symptom severity and this avoidance can be detrimental to the individual’s quality of life.
Negative reactions from others and a fear of such reactions can be one challenge of the skin disease experience that has to be met. Often, when people develop any severe or chronic ailment, they will question why they have developed the condition or what they have done to deserve this disease.
This kind of thought process often implies a sense of punishment for some kind of wrongdoing and can carry feelings of guilt. Indeed, very often people with skin diseases link skin lesions to sexual causation and contagion themselves.
Furthermore, when there is an insult to one’s ‘normal’ sense of self which falls short of the ‘ideal self’, feelings of shame often ensue.
Thoughts and concerns about the skin lesion are often displaced onto the self as a whole, as though patients form the syllogism: skin lesions are ugly, I have skin lesions, therefore I am ugly.
Skin conditions caused by stress and anxiety?
Skin is the most outer, biggest and most innervated organ can show the burden of stress in most obvious way. Thus, stress plays a major role in expression of many skin diseases which can either appear de novo or relapse in response to psychological stress. Among common examples are dermatitis, psoriasis, hair disorders, urticaria, skin infections, acne etc.
To understand how stress and anxiety can affect the skin, we must first understand a little about the endocrine system. The endocrine system is comprised of a number of glands that produce hormones and, when everything is in place, it allows the human body to work like a well-oiled machine.
However, when factors such as stress intervene, this intricate system can slip out of sync. During moments of tension the body produces excess cortisol, often referred to as the “stress hormone”, which wreaks havoc on everything from your immune system to blood pressure.
Physically: Stress increases cortisol production from the adrenal glands, which in turn increases sebaceous gland activity, to produce more oil and sebum. The result can be acne and increased sensitivity of our skin.
Moreover, stress produce various pro-inflammatory substances leading to
inflammation within the skin initiating the classic itch-scratch cycle. Any
stressful event leading to psychological stress can cause exacerbating itch and scratch cycle that is central to many dermatological conditions.
And in other direction, itchy skin associated with skin diseases can cause stigma leading to anxiety and mood problems giving rise to major psychiatric difficulties.
The onset and consequences of stress can often form a vicious cycle. Anxiety
and/or stress, which can be caused by skin conditions such as eczema, in fact canexacerbate the condition due to the body’s inflammatory responses such as
producing cortisol or interrupting sleep.
The overall appearance of the skin, even when minimally awed, can have a profound effect on the body image especially during adolescence and young adulthood when the individual is especially vulnerable to peer disapproval and social exclusion including bullying.
How can skin affect our mental health and cause stress and anxiety?
The skin serves as the boundary between ourselves and the outside world, a ‘first point of contact’ when strangers meet us. It is also the largest organ of the body.
Dermatological disorders have an immediate impact on us our tactile
communication, sexual contact and bodily interaction in particular. It might lead to fear, anxiety and shame.
Unlike most internal illnesses, skin problem is often immediately visible to others and therefore people suffering from dermatological conditions may suffer social and emotional consequences.
Since most skin conditions are accompanied by pain and discomfort, it can be
difficult to assess the differential and combined effects of the physiological and
psychosocial aspects of the condition on an individual’s quality of life and self-esteem.
Some of the issues which have been explored in recent research have tended
to focus on morbidity in the areas of depression, anxiety, self-esteem, body image, quality of life and relationship/sexual issues.
This focus on the potential psychosocial conflict caused by dermatological conditions indicates the range of issues pertinent to the holistic experience of skin disease.
The overall appearance of the skin, even when minimally awed, can have a
profound effect on the body image especially during adolescence and young
adulthood when the individual is especially vulnerable to peer disapproval and
social exclusion including bullying.
Moreover, our skin, especially facial skin, is one of the most easily visible
indicators of chronological age. The idea that chronological age itself does not
signal the beginning of old age, and that one can get older without the signs of
ageing, has become increasingly prevalent .
Over the last several decades old age has started to acquire increasingly negative connotations and often normal intrinsic ageing is viewed as a medical and social problem that needs to be addressed by health care professionals and an ageing appearance can be a source of significant distress .
Cutaneous body image dissatisfaction and resultant interpersonal sensitivity and feelings of social alienation have been associated with increased suicide risk.
What strategies can help us to cope with stress?
There isn’t one single method for treating skin that’s under stress. It is important to be aware that your body is under stress and trying to find ways to either tolerate the stress or find ways to release the stress.
Since stress is experienced very subjectively the way to ameliorate should be found through the trial and error method. I would say it requires a holistic approach.
There isn’t one right answer for each person, but there are different things that will work for each individual, depending on what their stress triggers are.
It means that first we need to figure it out what causes me stress.
So if you know you’re about to enter a stressful period, try to build in time for the activities that will help you to feel calm and rested – your skin will thank you. It is also important to have a good repertoire of coping strategies for managing stress that work for you before during and after stress.
If you are facing a stressful situation you can also think of some emergency actions. Even though it sounds silly or too simple but the science proves it works and there is a strong evidence of it!!!
Emergency actions for calming stress
1. Power posture:
Harvard research. that people who adopt open, expansive, “power” poses do feel more powerful. very strong” evidence that expansive vs. contractive (such as self-hugging) postures have other emotion-related effects, including affecting participants’ recall of positive vs. negative memories, their
self-evaluations, their specific emotional state, and their ability to recover from a negative mood.
Even a forced smile can lead to a mood boost. So if you’re feeling
down in the dumps, smiling will give you a boost—if you can get your moody self to smile.
Remember that changing your behaviour by smiling can change your inner feelings. In other words, if you “Put On a Happy Face,” you will actually
Stress reduction, insomnia prevention, emotion control, improved attention—certain breathing techniques can make life better.
5 Ways to manage stress on a daily basis
Having a good daily routine is extremely important
1. Good sleep settling in a dark room with no bright screens an hour before bed and waking up at the same time each day.
2. Proper diet and hydration.
3. Balance between work and pleasure.
4. Relaxation techniques according to your own preferences and time available
which have effects on muscle tension, blood flow, heart rate.
For example, meditation which is primarily directed at minimising sympathetic reactivity and enhancing parasympathetic function.
5. Create for yourself a nice self-care routine where you enjoy doing something
simple like a face massage and a mask or using oils, lavender oil aromatherapy.
I would suggest to incorporate those things into your daily ‘to do list’ even set an alarm clock for a lunch or a glass of water.
If you think it is not very important, you should consider whether you have a
good relationship with yourself to not?
10 smart ways to minimise stress!
1. Be active mentally and physically.
When you plan your daily timetable, have a go at including activities that keep both your mind and body active. For example, read a book.
It’s also important to keep physically active.
For example doing rigorous housework for 30 minutes, or an online exercise video, walk, cycle, run, take up yoga.
Find an activity that you enjoy otherwise it becomes stressful!
2. Connect with others.
For example, speak to a friend or colleague. We are social beings, so we need and naturally crave closeness and connection with other people. With the current health crisis many of us may be physically isolated or distant from others, so it’s important that we consider creative ways to connect in order that we don’t become socially isolated and lonely.
How can you continue to connect with family and friends and have social time in a virtual way? Perhaps using social media, phone and video calls you could set up shared online activities e.g. a virtual book or film club.
You could also explore local online neighbourhood groups, and see if there are ways to be involved in helping your local community.
3. Take notice and practice mindfulness.
For example, reflect on what is going on around you. Learning and practising
mindfulness can help us to let go of worries and bring ourselves back to the present moment.
For example still your mind or focus on the gentle movement of your breath or the sounds you hear around you, can serve as helpful ‘anchors’ to come back to the present moment and let go of worries. Connect to yourself.
4. Learn something new.
Learning new things helps us build self- esteem. For example, sign up for a course, learn a new skill from a friend.
5. Give back
Giving back to others makes us feel good. For example, volunteer in your
community, help others with shopping/ tasks.
6. Practice gratitude.
At times of uncertainty, developing a gratitude practice can help you to connect with moments of joy, aliveness, and pleasure. At the end of each day, take time to reflect on what you are thankful for today.
Try and be specific and notice new things each day, for example ‘I am grateful that it was sunny at lunchtime so I could sit in the garden’.
You could start a gratitude journal, or keep notes in a gratitude jar. Encourage other people in your home to get involved too.
7. Notice and limit worry triggers.
As the health situation develops it can feel like we need to constantly follow the news or check social media for updates. However, you might notice this also triggers your worry and anxiety.
Try to notice what triggers your worry. For example, is it watching the news for more than 30 minutes? Checking social media every hour? Try to limit the time that you are exposed to worry triggers each day.
You might choose to listen to the news at a set time each day, or you could limit the amount of time you spend on social media for news checking.
8. Practise identifying whether your worry is ‘real problem’ worry, or ‘hypothetical worry’.
If you’re experiencing lots of hypothetical worry, then it’s
important to remind yourself that your mind is not focusing on a problem that you can solve right now, and then to find ways to let the worry go and focus on something else. AndPractise postponing your worry. Worry is insistent – it can make you feel as though you have to engage with it right now. But you can experiment with postponing hypothetical worry, and many people find that this allows them to have a different relationship with their worries. In practice, this means deliberately setting aside time each day to let yourself worry (e.g. 30 minutes at the end of each day). It can feel like an odd thing to do at first! It also means that for the other 23.5 hours in the day you try to let go of the worry until you get to your ‘worry time’.
9. Look After Your Wellbeing By Finding Balance between achievements and
Whether you are working from home, or in some form of physical isolation or
distancing, it can be helpful to organise a daily routine that involves a balance
between activities that: give you a sense of achievement, help you feel close and connected with others and activities that you can do just for pleasure.
We feel good when we have achieved or accomplished something, so it’s helpful to include activities each day that give you a sense of achievement.
For example, doing some housework, decorating, gardening, a work task, cooking a new recipe, completing an exercise routine, or completing ‘life admin’ such as paying a bill.
Bur it so important to offload information at the end of each day do something
that feels good.
10. Speak to yourself with compassion and build good relationship with yourself!
Worry can come from a place of concern – we worry about others when we care for them. A traditional cognitive behavioural therapy technique for working with negative, anxious, or upsetting thoughts is to write them down and find a different way of responding to them.
Author: Angelika Grechnaya, MSc Psychology & MSc Organisational Psychology.