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Cited by 285Stress Responses and CortisolHealth, psychology, and well-beingStress and Burnout Research

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Stress and the Individual: Mechanisms Leading to Disease

McEwen, Bruce S.·1993·Archives of Internal Medicine
DOI 10.1001/archinte.1993.00410180039004
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Abstract

Objective This article presents a new formulation of the relationship between stress and the processes leading to disease. It emphasizes the hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events. It also presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.Data sources Published original articles from human and animal studies and selected reviews. Literature was surveyed using MEDLINE.Data extraction Independent extraction and cross-referencing by us.Data synthesis Stress is frequently seen as a significant contributor to disease, and clinical evidence is mounting for specific effects of stress on immune and cardiovascular systems. Yet, until recently, aspects of stress that precipitate disease have been obscure. The concept of homeostasis has failed to help us understand the hidden toll of chronic stress on the body. Rather than maintaining constancy, the physiologic systems within the body fluctuate to meet demands from external forces, a state termed allostasis. In this article, we extend the concept of allostasis over the dimension of time and we define allostatic load as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful.Conclusions This new formulation emphasizes the cascading relationships, beginning early in life, between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease. There are now empirical studies based on this formulation, as well as new insights into mechanisms involving specific changes in neural, neuroendocrine, and immune systems. The practical implications of this formulation for clinical practice and further research are discussed.

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  • The adverse effect of psychological stress on health behaviours such as food choice, physical activity and adherence to medication also contributes to T2DM risk.

    “The adverse effect of psychological stress on health behaviours such as food choice, physical activity and adherence to medication also contributes to T2DM risk”

    From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [13]

  • Changes in eating behaviour are a potential response to chronic stress in humans.

    “changes in eating behaviour are a potential response to chronic stress in humans 13.”

    From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [13]

  • The biological changes that occur as a result of chronic stress do not happen in isolation and are often exacerbated by unhealthy behaviours such as poor diet, physical inactivity, smoking and reduced adherence to medication.

    “The biological changes that occur as a result of chronic stress do not happen in isolation and are often exacerbated by unhealthy behaviours such as poor diet, physical inactivity, smoking and reduced adherence to medication 13 .”

    From Type 2 diabetes mellitus and psychological stress — a modifiable risk factor (2017) · cites this paper as [13]

  • Allostatic mediators work as a nonlinear, sometimes reciprocating, network, so too much or too little of each mediator can perturb the entire network, leading to harmful consequences.

    “Allostatic mediators work as a nonlinear, sometimes reciprocating, network (Fig. 1), meaning that too much or too little of each mediator can perturb the entire network, leading to harmful consequences.”

    From Sleep Deprivation and Circadian Disruption (2015) · cites this paper as [2]

  • Chronically increased allostasis can lead to disease.

    “Because chronically increased allostasis can lead to disease, we introduced the term “allostatic load or overload” to refer to the wear and tear that results from either too much stress or from inefficient management of allostasis, eg, not turning off the response when it is no longer needed.”

    From Protective and damaging effects of stress mediators: central role of the brain (2006) · cites this paper as [3]

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Metadata

Authors
McEwen, B. S.
Corresponding author
McEwen, Bruce S.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
1993-09-27
Volume
153
Issue
18
Pages
2093
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.1993.00410180039004
OpenAlex
W7214176958
Cited by
103
References
0
Citations by year
2026: 50 · 2025: 1 · 2024: 6 · 2023: 9 · 2022: 2 · 2021: 7 · 2020: 5 · 2019: 3 · 2017: 2 · 2016: 3 · 2015: 5 · 2014: 1 · 2013: 2 · 2012: 1
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Locations
Archives of Internal Medicine (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
Keywords
stress, individual differences, psychological stress, stress response

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