Women & Stress: Helping Patients Cope

Women and men show strong differences in how they respond to stress.

Like the common cold, stress is inevitable. An American Psychological Association poll revealed that up to one-third of Americans report stress in their lives, and up to 20% report stress on 15 days or more per month.¹

Stress is the bodily reaction to environmental changes. Environmental changes include both negative (eg, inadequate finances) and positive events (eg, getting married). Common stressors include death of spouse or friend, marriage, divorce, marital separation, losing a job, employment, major injury, illness, pregnancy, and retirement.² Stress-related symptoms are behavioral, psychological, and physiologic and include anxiety, reduced sex drive, irregular periods, acne breakouts, hair loss, poor digestion, depression, insomnia, weight gain, substance abuse, and decreased fertility.³ Individual responses to stress vary significantly depending on multiple factors, such as gender, age, living arrangements, employment, and childhood experiences.

Gender Differences

Strong gender differences exist in how men and women respond to stress(Table 1).^3-8 Feelings of stress are rooted in the body’s instinct to defend itself from predators and aggressors. When stress occurs, cortisol and epinephrine are released, increasing blood pressure and the circulating blood sugar level. A third hormone, oxytocin, is secreted by the pituitary gland, which counters the production of cortisol and epinephrine, resulting in behavioral and emotional attenuation. Women secrete higher levels of oxytocin compared with men.⁶ Along with having lower levels of oxytocin, men also release testosterone, which fuels aggression.^6,7 These hormonal differences help explain gender-specific behavioral responses to stress.

The human stress response is characterized by physiologic and behavioral factors described as “fight or flight.” Although fight and flight are primary physiologic stress responses for both sexes, behaviorally, females’ responses are also marked by a pattern to “tend and befriend.” Tending involves nurturing activities, designed to protect the self and offspring, that promote safety and reduce distress. Befriending is the creation and maintenance of social networks that also help to reduce stress. Neuroendocrine evidence from animal and human studies suggests that oxytocin, in conjunction with female reproductive hormones and endogenous opioid peptide mechanisms, may be at the core of tend and befriend.⁹

Acute Versus Chronic Stress

Stress can be short term, lasting a few hours or days (eg, losing a house key), or chronic (eg, having an overly demanding job). Employment is a major cause of chronic stress: up to 75% of Americans report work is stressful.⁷ Chronic stress is associated with increased risk for coronary disease (especially for those younger than 50 years), eating disorders, emotional disorders (eg, depression, anxiety), ulcers, sexual dysfunction, irregular periods, accidents, hair loss, colds and infections, and alcohol and substance abuse.^7,10,11

Stress and Aging

Aging precipitates additional stressors, including death of a loved one, accidents, life-threatening diseases, chronic diseases, medications and their side effects, and sleep disturbances.⁷ Evidence suggests that disturbances in the hypothalamic— pituitary–adrenal (HPA) axis, which controls the stress response, compound certain health problems that are common among older people, such as cardiovascular disease and stroke. Aging and long-term stress both appear to trigger HPA disturbances. In addition, constant exposure to certain stress hormones, such as cortisol, is harmful to nerve cells in the hippocampus, potentially affecting learning and memory processing.⁷

Treatment

Counseling and psychotherapy are first-line treatments. Their objective is to assist the individual in developing positive coping skills. Cognitive behavior therapy is particularly effective in teaching new coping skills, along with minimizing stress-induced low self-esteem and other negative feelings.

Those with acute severe stress are candidates for pharmacotherapy. Benzodiazepines are recommended for short-term treatment of anxiety. Patients are started at the lowest possible doses before higher doses are prescribed. Serotonin reuptake inhibitors are recommended for stress-induced depression. Zolpidem is used to treat stress-induced insomnia.¹² Chronic stress often mandates both pharmacotherapy and counseling. In some cases, chronic stress may only be resolved with a major lifestyle modification.

Counseling Guidelines

It’s important to recognize that stress responses are highly individualized. Consequently, counseling needs vary for each patient. For patients on medication, counseling begins by reviewing each medication and its side effects. Emphasize the importance of nonmedication interventions such as counseling to help develop better coping mechanisms. Table 2 summarizes guidelines for counseling patients with stress.

Final Thought

Stress is inevitable, but its effects can be minimized by controlling its sources and improving coping skills. When counseling patients, a few kind words can show compassion and can help significantly!

Dr. Zanni is a psychologist and health-systems consultant based in Alexandria, Virginia.

References

• University of Maryland Medical Center. Stress. www.umm.edu/altmed/articles/stress-000158.htm. Accessed May 14, 2013.
• WomensHealth.gov. Stress and your health. www.womenshealth.gov/publications/our-publications/fact-sheet/stress-your-health.cfm. Accessed May 10, 2013.
• Gregoire C. Ten ways stress affects women’s health. The Huffington Post. www.huffingtonpost.com/2013/01/30/health-effects-of-stress-_n_2585625.html. Accessed May 10, 2013.
• American Psychological Association. Gender and stress. www.apa.org/news/press/releases/stress/2012/gender.aspx. Accessed May 10, 2013.
• Weber L, Shellenbarger S. Office stress: his vs. hers. The Wall Street Journal. http://online.wsj.com/article/SB10001424127887324678604578340332290414820.html. Accessed May 10, 2013.
• Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA. Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev. 2000;107:411-429.
• HelpGuide.org. The many faces of stress. www.helpguide.org/harvard/faces_of_stress.htm. Accessed May 10, 2013.
• Popovich N. How women experience stress: what the research tells us. The Guardian. www.guardian.co.uk/lifeandstyle/2013/mar/14/women-experience-stress-work-research. Accessed May 10, 2013.
• Nauert R. Response to stress is gender specific. http://psychcentral.com/news/2007/11/20/response-to-stress-is-gender-specific/1559.html. Accessed May 10, 2013.
• Cleveland Clinic. Emotional wellbeing. http://my.clevelandclinic.org/healthy_living/Stress_Management/hic_Stress_and_Women.aspx. Accessed May 10, 2013.
• Mayo Clinic. Chronic stress puts your health at risk. Accessed May 10, 2013.
• Medscape psychiatry and mental health education. Expert column: stress, anxiety, and insomnia: what every pcp should know. www.medscape.org/viewarticle/495354. Accessed May 10, 2013.
• FamilyDoctor.org. Stress: how to cope with life’s challenges. http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health/stress-how-to-cope-better-with-lifes-challenges.html. Accessed May 10, 2013.
• The Patient Education Institute, Inc. Managing stress. www.nlm.nih.gov/medlineplus/tutorials/managingstress/hp069103.pdf. Accessed May 10, 2013.
• Mayo Clinic. Coping with stress: workplace tips. www.mayoclinic.com/health/coping-with-stress/SR00030. Accessed May 10, 2013.