D.

UNDERSTANDING STRESS
1. Acute and long-term effects of Stress
- Physical Responses
-Psychological Responses
2. General Adaptation Syndrome (GAS)
3. Psychoneuroimmunological Mode
4. Measuring Stress and Coping Styles

E. DIAGNOSIS- DSM 1V-V

Submitted to:
Dr. Richard O. Lam, RN, MAN, PhD

Submitted by: Group 3 (BSN-3 A2)

Jane Arellano
Flore Mae Basay
Mercy Bett
Gillian Cañas
Princess Eilaine de Dios
Merry Joy Inot
Angel Mondaya
Adrienne Khyle Ong
Mary Joy Torrevillas
 D. UNDERSTANDING STRESS

Acute and Long-Term Effects of Stress

Stress can have both acute (short-term) and long-term effects on the body and mind. It is
important to note that not all stress is harmful; short-term stress can be a natural and adaptive
response to challenging situations. However, chronic, or excessive stress can lead to various
health problems. Here are the acute and long-term effects of stress:

Acute Effects of Stress:

1. Fight or Flight Response: Stress triggers the body's "fight or flight" response, releasing
hormones like adrenaline and cortisol. This response prepares the body to react quickly to a
perceived threat.
2. Increased Heart Rate and Blood Pressure: The release of adrenaline causes the heart rate and
blood pressure to rise, redirecting blood flow to essential organs.
3. Heightened Awareness: Stress can sharpen focus and increase alertness temporarily, helping
individuals respond to immediate challenges.
4. Muscle Tension: Stress can lead to muscle tension, preparing the body for physical activity in
response to a stressor.
5. Short-Term Memory Formation: Stress can enhance short-term memory and cognitive
function, aiding in quick decision-making.

Long-Term Effects of Chronic Stress:

1. Physical Health Issues:
- Cardiovascular Problems: Chronic stress is associated with an increased risk of heart disease,
hypertension, and other cardiovascular issues.
- Immune System Suppression: Prolonged stress can weaken the immune system, making
individuals more susceptible to infections and illnesses.
- Digestive Problems: Stress may contribute to digestive issues such as irritable bowel
syndrome (IBS), indigestion, and stomach ulcers.
2. Mental Health Issues:
- Anxiety and Depression: Chronic stress is a significant contributor to the development or
exacerbation of anxiety and depression.
 - Cognitive Impairment: Long-term stress can negatively impact cognitive function, affecting
memory and concentration.
- Sleep Disturbances: Stress can disrupt sleep patterns, leading to insomnia or poor-quality
sleep.
3. Weight Gain or Loss:
- Appetite Changes: Stress can affect eating habits, leading to overeating or loss of appetite,
potentially resulting in weight gain or loss.
4. Hormonal Imbalances:
- Endocrine Disruption: Chronic stress can disrupt hormonal balance, affecting the
reproductive system and leading to menstrual irregularities or fertility issues.
5. Increased Risk of Chronic Diseases:
- Diabetes: Stress has been linked to insulin resistance and an increased risk of developing type
2 diabetes.
- Autoimmune Disorders: Chronic stress may contribute to the development or exacerbation of
autoimmune conditions.
6. Behavioral Changes:
- Substance Abuse: Some individuals may turn to alcohol, drugs, or other substances to cope
with chronic stress.
7. Premature Aging:
- Cellular Aging: Chronic stress has been associated with accelerated cellular aging, potentially
affecting overall longevity.

To mitigate the negative impact of stress on physical and mental well-being, it is essential to
manage and cope with stress through healthy strategies such as regular exercise, adequate sleep,
social support, and relaxation techniques. Seeking professional help from healthcare providers or
mental health professionals is advisable if stress becomes overwhelming.
Physical Responses

When we experience stress, our body undergoes various physiological changes that are primarily
mediated by the autonomic nervous system and the release of stress hormones. These changes
are part of the body's adaptive mechanisms to cope with stressors and help us deal with
immediate threats. Let's take a closer look at the physical responses to stress.

Activation of the Sympathetic Nervous System (SNS):

The SNS is responsible for the "fight or flight" response, which prepares the body to respond to a
perceived threat. When the SNS is activated, norepinephrine and adrenaline (epinephrine) are
released, leading to increased heart rate, blood pressure, and respiratory rate.

Release of Stress Hormones:

Cortisol, often referred to as the "stress hormone," is released from the adrenal glands in
response to stress. It helps regulate various physiological processes, including metabolism and
immune function. Adrenaline (Epinephrine) enhances the body's alertness, preparing it for a
rapid response to a stressor.

Muscle Tension:
Stress can lead to the tightening of muscles, especially in the neck, shoulders, and back. This
muscle tension is part of the body's readiness for physical action.

Dilated Pupils:
Under stress, the pupils of the eyes dilate, allowing lighter to enter and improving vision, which
can be helpful in heightened alertness situations.

Increased Blood Flow to Muscles:

Blood is redirected from non-essential functions, like digestion, to the muscles, providing them
with more oxygen and nutrients for a quick physical response.
Gastrointestinal Changes:
Stress can affect the digestive system, leading to changes in appetite, nausea, or stomach
discomfort. The "fight or flight" response may temporarily suppress digestive processes.

Respiratory Changes:
Breathing becomes faster and shallower to increase oxygen intake, supporting heightened
physical activity.

Sweating:
The body may produce more sweat to regulate temperature during increased physical exertion.

Increased Heart Rate:

The heart rate rises to pump more blood, delivering oxygen and nutrients to vital organs and
muscles.

Immune System Changes:

While acute stress can temporarily enhance the immune response, chronic stress may lead to
immune system suppression, increasing susceptibility to illness.

Elevated Blood Sugar Levels:

Stress hormones can stimulate the release of glucose into the bloodstream, providing additional
energy for the body's immediate needs.

Changes in Skin Conductance:

Stress can lead to changes in skin conductance, influencing factors like skin moisture.

While these physical responses to stress are crucial for survival in the short term, chronic
activation of the stress response without adequate recovery can contribute to health issues over
time. Therefore, it is essential to manage stress effectively through relaxation techniques, regular
exercise, and healthy coping strategies for overall well-being.
Psychological Responses
Stress is a complex psychological response to challenging situations, and it can have
profound effects on individuals' thoughts, emotions, and behaviors. The psychological responses
to stress can vary widely among individuals, depending on several factors like the type, duration,
and intensity of the stressor, as well as an individual's coping mechanisms, personality traits, and
social support network.

Cognitive Changes:
Stress can lead to difficulties in concentrating and focusing on tasks. Chronic stress may also
negatively impact short-term and working memory, making it challenging to retain and recall
information. Individuals under stress may experience a rapid flow of thoughts, making it
challenging to control the mind.

Emotional Responses:
Stress often manifests as heightened anxiety, characterized by excessive worrying, restlessness,
and a sense of unease. Individuals may become more irritable and easily frustrated under stress.
Stress can contribute to mood swings, with individuals experiencing a range of emotions from
sadness to anger.
Depression:
Chronic stress is a risk factor for the development or exacerbation of depression. Persistent
feelings of hopelessness and low mood can be associated with ongoing stressors.
Changes in Sleep Patterns:
Stress can disrupt sleep, leading to difficulties falling asleep, staying asleep, or experiencing
restful sleep. Insomnia is a common psychological response to stress.
Appetite Changes:
Stress can affect eating habits, leading to either overeating or loss of appetite. Emotional eating,
particularly the consumption of comfort foods, may occur.
Social Withdrawal:
Individuals experiencing stress may withdraw from social activities and isolate themselves from
others.
Coping Mechanisms:
People often develop coping mechanisms in response to stress, which can be adaptive or
maladaptive. Adaptive coping strategies include seeking social support, problem-solving, and
engaging in relaxation techniques. Maladaptive strategies may include substance abuse,
avoidance, or overeating.

Decreased Motivation:
Chronic stress can lead to a lack of motivation and decreased interest in once enjoyable
activities.
Increased Sensitivity to Stressors:
Ongoing stress may make individuals more sensitive to additional stressors, amplifying the
impact of daily challenges.

Psychosomatic Symptoms:
Stress can manifest as physical symptoms with no clear medical explanation, such as headaches,
gastrointestinal issues, or muscle pain.

Negative Self-Talk:
Individuals under stress may engage in negative self-talk, where they criticize themselves or
doubt their abilities.

Feelings of Helplessness:
Prolonged exposure to stressors can lead to a sense of helplessness and a perception that one has
little control over their circumstances.

It's important to note that we respond to stress in unique ways, and not everyone will experience
the same psychological reactions. Effective stress management often involves a combination of
self-awareness, coping skills, and seeking support from friends, family, or mental health
professionals when needed. Developing resilience and cultivating healthy coping mechanisms
can contribute to better psychological well-being in the face of stressors.
The figure presents a transdisciplinary model that describes psychological stress as
encompassing a set of interrelated processes. The figure illustrates that stressors are experienced
within the context of a person’s life, represented by the contextual factors in the blue triangle.

These contextual factors include individual-level characteristics such as personality and

demographics, the environment in which one lives, current and past stressor exposures, and
protective factors—all of which combine to determine the baseline allostatic state of
physiological regulation, and the lens through which stressors are perceived and assigned
meaning.

Contextual factors and habitual processes together influence psychological and physiological
responses to acute and daily stressors. These responses, if dysregulated, are thought to lead to
allostatic load and ultimately biological aging and early disease.
2. General Adaptation Syndrome (GAS)

The General Adaptation Syndrome (GAS) is a theoretical framework developed by Hans Selye,
an endocrinologist from Hungary, in the mid-20th century. Selye proposed that the body's
response to stress follows a three-stage pattern, which he called the General Adaptation
Syndrome. The three stages are Alarm, Resistance, and Exhaustion, and each stage is
characterized by different physiological and psychological responses.

The Alarm Stage is the initial reaction to a stressor, and it triggers the body's "fight or flight"
response. During this stage, the body recognizes a threat and activates the sympathetic nervous
system. The body responds by increasing heart rate, rapid breathing, and the release of stress
hormones (especially adrenaline) to prepare for the stressor.

The Resistance Stage is the second phase of the General Adaptation Syndrome. If the stressor
continues, the body enters the "resistance stage." During this phase, the body tries to adapt to the
ongoing stress by activating various physiological mechanisms. The body continues to cope with
the stressor, and some of the initial physiological responses may decrease. The Resistance Stage
is characterized by a decrease in the level of stress hormones in the body, and the body's ability
to cope with the stressor becomes more efficient.

The Exhaustion Stage is the last phase of the General Adaptation Syndrome. If the stressor
persists for a prolonged period, and the body cannot cope effectively, it enters the "exhaustion
stage." During this phase, resources are depleted, and the body's ability to resist further stress
diminishes. This stage is characterized by increased vulnerability to illness, fatigue, and a decline
in overall physiological functioning. If the stressor persists, the body may experience long-term
damage, and the individual may develop chronic health problems.

It's important to note that Selye's General Adaptation Syndrome primarily focuses on the
physiological aspects of stress and was initially based on his research with laboratory animals.
While the concept has been influential in understanding the body's response to stress, modern
research recognizes that stress is a complex and multifaceted phenomenon involving not only
physiological but also psychological and behavioral components.

Moreover, the GAS model is criticized for oversimplifying the stress response and not fully
capturing the individual variability in responses to stressors. Different people may react
differently to stressors, and the impact of stress is influenced by factors such as genetics, coping
mechanisms, and social support. Therefore, contemporary models of stress consider the interplay
of biological, psychological, and social factors in shaping an individual's response to stressors.

Despite its limitations, the General Adaptation Syndrome has contributed to the understanding of
how the body responds to stress and has influenced subsequent research on stress and adaptation.
By identifying the three stages of the stress response, the GAS model has provided a useful
framework for understanding the complex physiological and psychological changes that occur
when an individual is exposed to stress.

3. Psychoneuroimmunological Mode

The Psychoneuroimmunological (PNI) model is an interdisciplinary field of study that examines

the interactions between psychological processes, the nervous system, and the immune system.
This model recognizes the complex connections between the mind and body, emphasizing how
psychological factors may influence the immune response and overall health.

The Psychoneuroimmunological model includes the following key components:

Psychological Factors:
- Stress: Psychological stress, whether acute or chronic, has been linked to changes in immune
function. Stress can activate the body's "fight or flight" response, releasing stress hormones such
as cortisol and adrenaline, which can impact the immune system.
- Emotional States: Positive emotions, such as joy and optimism, have been associated with a
more robust immune response, while negative emotions, such as chronic stress, anxiety, or
depression, can contribute to immune system dysregulation.
- Cognitive Factors: Thoughts, beliefs, and perceptions can influence immune function. For
example, a positive outlook or a sense of control over one's life may positively impact immune
responses.

Neurological Factors:
- Neurotransmitters: The communication between the nervous system and the immune system
involves neurotransmitters. For instance, substances like norepinephrine and serotonin, which are
involved in mood regulation, can also influence immune cell activity.
- Central Nervous System (CNS): The central nervous system, including the brain and spinal
cord, plays a role in regulating immune responses. The brain can send signals to the immune
system through neural pathways and the release of signaling molecules.

Immunological Factors:
- Immune Cells: Various immune cells, such as T cells, B cells, and natural killer cells, are
involved in defending the body against pathogens. These cells can be influenced by signals from
the nervous and endocrine systems.

- Cytokines: These signaling molecules play a crucial role in immune responses. Stress and
psychological factors can influence the production and release of cytokines, impacting
inflammation and immune function.

Endocrine Factors:
- Hormones: Hormones, particularly stress hormones like cortisol, are released by the endocrine
system in response to stress. These hormones can modulate immune cell activity and the
inflammatory response.

Behavioral Factors:
- Lifestyle and Health Behaviors: Health-related behaviors, such as sleep, nutrition, exercise, and
substance use, can impact both psychological well-being and immune function. Positive lifestyle
choices contribute to overall immune resilience.

Research in psychoneuroimmunology has explored how factors such as chronic stress, social
relationships, and psychological interventions can influence immune responses and susceptibility
to illness. The field highlights the interconnectedness of psychological and physiological
processes and underscores the importance of a holistic approach to health that considers both
mental and physical well-being.
4. Measuring Stress and Coping Styles
Stress is a common and inevitable part of life, and it affects everyone differently.
Measuring stress and coping styles can help individuals understand their reactions to stressful
situations and develop effective strategies for managing stress. There are several tools available
to measure stress and coping styles, including self-report questionnaires and physiological
measures.

Self-report questionnaires are a common method of measuring stress and coping styles. These
questionnaires, such as the Perceived Stress Scale (PSS) and the Coping Inventory for Stressful
Situations (CISS), ask individuals to rate their levels of stress and coping behaviors. The PSS
assesses how often individuals perceive their life as stressful, while the CISS measures three
coping styles: task-oriented, emotion-oriented, and avoidance-oriented.

Physiological measures can also provide insight into an individual's stress response. These
measures include heart rate variability and cortisol levels. Heart rate variability measures the
variation in time between heartbeats and can be an indicator of stress levels. Higher heart rate
variability is generally associated with better stress management. Cortisol is a hormone released
in response to stress and can be measured in saliva, blood, or urine. Measuring cortisol levels can
provide an indication of an individual's overall stress levels over a period.

Understanding one's coping style can be particularly helpful in developing effective stress
management strategies. Task-oriented coping involves actively seeking solutions to a problem
and taking steps to address the issue. Emotion-oriented coping focuses on managing the
emotional response to stress and may involve techniques such as mindfulness meditation or self-
reflection. Avoidance-oriented coping involves avoiding or denying the problem, which can lead
to increased stress levels over time.

Overall, measuring stress and coping styles can be a useful tool in developing a personalized
approach to stress management. By understanding their stress response and coping style,
individuals can take steps to manage their stress levels and improve their overall well-being.
E. DIAGNOSIS- DSM IV-V

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), was
published by the American Psychiatric Association in 1994. It was a comprehensive
classification system and diagnostic tool widely used by mental health professionals for the
assessment and diagnosis of mental disorders.

Here are some key features of DSM-IV:

1. Multiaxial System:
DSM-IV introduced a multiaxial system with five axes to provide a comprehensive and holistic
assessment of an individual's mental health. Axes I and II focused on clinical syndromes and
personality disorders/mental retardation, respectively. Axes III and IV considered general
medical conditions and psychosocial and environmental factors. Axis V assessed the individual's
level of functioning on a Global Assessment of Functioning (GAF) scale.

2. Categorical Approach:
The manual primarily used a categorical approach to diagnosis, where mental disorders were
classified into distinct categories with specific diagnostic criteria.

3. Clinical Disorders:
DSM-IV included a wide range of clinical disorders, including mood disorders (e.g., major
depressive disorder, bipolar disorder), anxiety disorders, psychotic disorders, and more.

4. Personality Disorders:
Personality disorders were classified on Axis II, encompassing conditions like borderline
personality disorder, narcissistic personality disorder, and antisocial personality disorder.

5. Text and Criteria:

Each mental disorder was accompanied by a detailed description of symptoms, diagnostic
criteria, and additional information.
6. Global Assessment of Functioning (GAF):
The GAF scale on Axis V provided a numerical rating (ranging from 1 to 100) to assess an
individual's overall psychological, social, and occupational functioning.

7. Updates and Revisions:

DSM-IV-TR (Text Revision) was released in 2000, providing updates and clarifications to the
original DSM-IV.

It's worth noting that the DSM-IV was influential in shaping the field of psychiatry, facilitating
communication among mental health professionals, and guiding research and treatment
approaches. However, over time, advances in research and changes in the understanding of
mental disorders led to the development of the fifth edition, DSM-5, which was published in
2013. The DSM-5 introduced significant changes, including a dimensional approach to diagnosis
and revisions to the classification of certain disorders.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a widely
used classification system and diagnostic tool published by the American Psychiatric Association
(APA). It was released in 2013 and is the latest version of the DSM as of my last knowledge
update in January 2022. Here are the key features and changes introduced in DSM-5:

1. Dimensional Assessment: DSM-5 takes a dimensional approach to assessment, emphasizing

the evaluation of symptom intensity and severity rather than a strict categorical system.

2. Reorganization of Disorders: The manual has reorganized and reclassified certain disorders
based on new research findings and a better understanding of mental health conditions.

3. Neurodevelopmental Disorders: DSM-5 introduced the category of "Neurodevelopmental

Disorders," which includes conditions such as autism spectrum disorder,
attention-deficit/hyperactivity disorder (ADHD), and intellectual disabilities.

4. Removal of Multiaxial System: Unlike DSM-IV, DSM-5 eliminated the multiaxial system and
integrated all disorders into a single-axis diagnostic approach.
5. Changes to Substance-Related Disorders: Substance-related disorders were redefined to
combine substance abuse and dependence into a single category called "substance use disorders."

6. New Disorders: DSM-5 includes new disorders such as disruptive mood dysregulation
disorder, premenstrual dysphoric disorder, excoriation (skin-picking) disorder, and hoarding
disorder.

7. Removal of GAF Scale: The Global Assessment of Functioning (GAF) scale, which was used
in DSM-IV to assess an individual's overall functioning, was removed in DSM-5.

8. Cultural Formulation Interview (CFI): DSM-5 includes the Cultural Formulation Interview,
which is a tool designed to help clinicians assess an individual's cultural background and its
impact on their mental health.

9. Changes to Personality Disorders: Personality disorders were reorganized in DSM-5, with the
removal of specific subtypes and the introduction of a dimensional trait model for the assessment
of personality pathology.

10. Use of Specifiers: DSM-5 introduced specifiers for many disorders to provide additional
details about the course, severity, or specific features of the condition.

11. Integration of Research Findings: The revisions in DSM-5 reflect advancements in

neuroscience, genetics, and clinical research in the field of mental health.

It's important to note that the DSM-5 is not without controversy, and ongoing discussions within
the mental health community address the evolving nature of psychiatric diagnoses and the need
for ongoing updates and revisions. Mental health professionals use the DSM-5 as a tool to guide
diagnosis and treatment planning, but it is essential to consider everyone’s unique circumstances
and to use a comprehensive approach to assessment.