Physical and psychological stress are natural experiences in all beings with complex neurological systems. On a biological level, the function of stress is to help us to respond and adapt to a changing environment to increase our chances of surviving and thriving.
While moderate, short-term stress, often called eustress, is generally beneficial to human wellbeing, intense, chronic, and cumulative stress can have a significantly negative impact on our physical, social, and mental health. In fact, when a person experiences chronic distress, all dimensions of human wellness are impacted.
Experiencing distress and feeling intensely overwhelmed can be maladaptive, meaning that it decreases our health and chances of survival in the long term. This is the case in terms of the impact of chronic stress and trauma on the immune system, even increasing the risk of developing an autoimmune disease.
This article summarizes the research on the impact of different types of stress on the immune system and how immune dysregulation as a result of stress can increase the risk of developing an autoimmune disease.
The Impact of Stress on the Immune System
The immune system is responsible for keeping our cells, organs, and systems safe from bacteria, viruses, and fungi, and foreign elements that could damage our bodies and acts to minimize damage after cuts, bumps, breaks, and scrapes. When the immune system is functioning properly, it quickly executes specific protective responses immediately after it detects potentially damaging organisms in the body.
The immune system is a complex system of cells, organs, and responses, which we describe in detail in this article about the impact of exercise on the immune system. When it is functioning as it should, it responds to elements it detects or comes into contact with in the environment, like toxins and pathogens, by identifying them and neutralizing or killing them, then eliminating them from the body.
Toxins and pathogens are called immune system stressors; they cause the immune system to act to maintain the integrity of the body and the cells.
Immune System Dysregulation
Several elements, both internal and external, can dysregulate the immune system response, or make it not work as it should.
- Diet: Not consuming enough energy or a diet lacking certain nutrients like zinc, vitamin C, and fatty acids, which are key to immune system function, may cause your immune system to lag.
- Exhaustion or lack of sleep: The immune system cells interleukin 1 and cytokines regulate certain sleep stages, and infections alter sleep.
- Sedentarism, or a lack of physical activity: Physical activity influences blood circulation and the secretion of stress hormones. Regular, moderate physical activity has a protective effect on the immune system.
- Previous infections or illnesses: A current illness or recent recovery from an illness can make a person more susceptible to getting ill again since the immune system is focused on fighting a current infection and reproducing immune cells.
- Exposure to xenobiotics and environmental stressors: Silica, smoke, solvents, metals, and other chemicals and substances in the environment can trigger or promote autoimmunity in healthy individuals.
- Stress: While the body can recover from short-term dips in immunity after acute stress, chronic stress, especially during key stages of development, can have a long-term detrimental effect on immune system function. A poor diet, exhaustion, and a history of illness all feed into a stress response. As this is the focus of this article, stress is discussed more in detail below.
Just like pathogens and toxins are immune system stressors, so is a nutrient-poor diet, lack of sleep, and sedentarism.
Psychological Stress and the Immune System
Stress can have a positive or negative impact on your health and wellbeing depending on the cause of the stress and the way it is experienced and managed. Psychologists usually divide stress into two different types: eustress and distress. Additionally, it can be categorized in terms of the longevity of the stress experience, namely, acute stress for short-term stress and chronic stress for that which is experienced for several days, months, or even years.
Eustress, which is stress that lasts a few minutes or hours and has a positive effect on your actions, is felt when you are nervous about a job interview, meeting a new person, planning a vacation, or listening to an inspirational podcast. Eustress energizes and motivates you to think about ways to overcome obstacles, get focused, or feel excited. At this time, the blood is flooded with certain kinds of cells like pro-inflammatory cytokines since your brain detects the risk involved in your situation. However, since eustress is associated with positive feelings, and the feeling of eustress is often followed by feelings of satisfaction or relief, the inflammatory cytokines are then eliminated from the bloodstream.
Distress, on the other hand, is a type of stress that negatively affects you, causing you to feel overwhelmed, disempowered, fatigued, or more or less hungry or sleepy than normal. Some examples of situations that cause distress are deadlines, financial crises, the death of a loved one, work problems, or abuse.
The graphic below illustrates the difference between eustress and stress. What is to the left of the peak is the result of eustress, and what is to the right, as the curve begins to dip, is the result of distress, especially chronic distress.
Acute stress is a type of stress that causes a fight or flight response. It lasts a few minutes or hours. It can be experienced as eustress, like when you are preparing for a date with your significant other, or it might be experienced as distress, like what occurs when you are startled by a prankster or a tight deadline.
Chronic stress is a type of distress that lasts from days to years and is associated with greater levels of pro-inflammatory cytokines that are present in the bloodstream constantly. Chronic stress might be experienced due to relationship problems, living in an area with violent conflict, racial or social discrimination, or a prolonged financial crisis. It is associated with a suppression of cellular and humoral measures of immune system function. In the case of chronic stress, the perceived risk is constant. This can cause systemic inflammation and, in turn, immune system dysregulation.
Psychological distress can dysregulate the immune system. Immune system dysregulation means that it can:
- Overreact when faced with potential pathogens
- Create autoantibodies, or antibodies that mistakenly attack the body’s own cells
- Underreact when faced with real threats to the body
Immune system dysregulation is a risk factor for developing chronic disease, including autoimmune disease.
It is important to note that while researchers are clear on the potential for psychological stress to dysregulate immune system function, stress can impact people’s immunity differently depending on their age, exposure to early adversity, and current illnesses at the time of experiencing stress, among others.
The Impact of Chronic Stress in Childhood and Autoimmune Disease
Infancy, childhood, and adolescence are the most important stages in human development. The brain and body grow and develop rapidly, and it is when humans learn how to act and interact with others to stay safe.
As mentioned in the previous section, chronic stress at any stage of life can dysregulate the immune system. However, there is a particularly strong association between the impact of chronic or cumulative stress in childhood (referred to generally as the stage in life before the age of 18) and the risk of developing chronic and autoimmune diseases.
One of the tools that help us to understand the severity of stressors in childhood and their impact on disease risk is the Adverse Childhood Experiences (ACE) Study. The ACEs study examined how experiencing different types of sexual, physical, or emotional abuse in childhood could impact future life circumstances and health.
It has been established that ACEs and other forms of childhood adversity have a negative impact on social and health outcomes later in life. This can be explained, in part, by the toxic stress caused by ACEs and similar situations. Essentially, toxic stress during key developmental stages can cause the immune system to learn from its surroundings differently, often causing dysregulation, which, in many cases, cannot be reversed.
A subsequent study to the original ACE study used the same tool to examine the impact of cumulative childhood stress on hospitalizations of any autoimmune disease. The study found that:
- First hospitalizations for any autoimmune disease increased with an increasing number of ACEs.
- Compared with persons with no ACEs, persons with two or more ACEs were at a
- 70% increased risk for hospitalizations with idiopathic myocarditis and diseases with similar markers
- 80% increased risk for myasthenia gravis and diseases that cause muscle weakness
- 100% increased risk for rheumatic diseases like rheumatoid arthritis.
In short, the researchers found that childhood traumatic stress increased the likelihood of hospitalization due to autoimmune diseases decades into adulthood.
Stress as a Trigger of Autoimmune Disease
Autoimmune disease risk is different from person to person due to the relationship between multiple, complex factors, including genetics, environmental, hormonal, and immunological factors.
Usually, there are key triggers that spark the onset of autoimmune diseases. However, people with multiple risk factors for autoimmune diseases may never develop an autoimmune condition if they aren’t exposed to key triggers, just as people with lower risk factors may develop complex autoimmune diseases after they experience key triggers.
In fact, researchers have estimated that more than 50% of autoimmune diseases are attributed to “unknown trigger factors.”
Stress, both physical and psychological, has been implicated as a primary trigger factor in the onset of numerous autoimmune diseases. Many studies report that up to 80% of patients with autoimmune disease experienced uncommon emotional stress prior to experiencing symptoms. The graphic below, based on a model developed by researchers Susan K. Lutgendorf and Erin S. Costanzo, demonstrates how different forms of stress play into the development of autoimmune disease.
Additionally, once people are diagnosed with autoimmune disease, they face several challenges that can be deeply stressful, such as navigating the healthcare system and experiencing discrimination in the workplace. These challenges are discussed more in detail in this article about Important Things to Remember When Working with Clients Who Have Autoimmune Disease.
A large cohort study carried out with over 100,000 patients in Sweden illustrates the relationship between stress and autoimmune disease. Researchers wanted to understand if the clinical diagnoses of stress-related disorders induced by trauma or other life stressors had an impact on the subsequent risk of autoimmune disease when compared to their siblings who hadn’t been diagnosed with the disorder. Researchers found that there was a significant increase in the risk of autoimmune disease development following a stress-induced psychiatric disorder.
How might stress trigger the onset of autoimmune disease? One of the primary theories among immunological researchers is that stress triggers the release of certain neuroendocrine hormones that alter or increase the production of cytokines, which help control and regulate the growth and activity of other immune cells. The significant increase in cytokine production dysregulates the immune response, ultimately resulting in autoimmune disease.
Autoimmune diseases are complex conditions with diverse manifestations that are becoming increasingly common in the US and around the world.
While there are multiple factors that can influence the risk of autoimmune disease, there has been an increasing interest in the trigger factors that lead to the manifestation of autoimmune diseases. Stress, especially when experienced in childhood, is strongly believed to be one of the factors that may increase the risk of autoimmune disease later in life. Stress, especially chronic stress experienced over several days or months, is very likely a triggering factor for autoimmune disease development.
As health coaches, knowing the multiple factors that increase the risk of and triggering of autoimmune disease can guide you in implementing methods and tools to support clients in identifying and managing stress in addition to adopting health behaviors, like diet, rest, and physical activity, that can help to strengthen the immune system.
If you want to learn about ways to support your clients in managing stress, read 6 Healthy Ways to Help Your Clients Cope with Stress & Anxiety.