Stress gets a bad reputation. Can you imagine getting a good grade in that college report if we didn’t stress about it? Stress improves our performance, our happiness and even our health. In fact, our immunological system is developed, in part, from the stimulation of inflammatory agents that at some point stressed our body.

Normal developmental worry is prevalent as we grow. When we are told what to wear, what to eat, where we are going, we have very little control and we learn to worry. The spectrum of worry–stress–anxiety, and brain networks associated with it, has been critical in our evolutionary relationship with our environment. When we lived in the jungle and we faced many predators and threats, it was advantageous to have a higher level of worry, stress, and anxiety than we need to have today. We have evolved to gain more control over our environment and a greater sense of safety, paralleled with the development of cortical regions of our brain. Yet the spectrum of stress and worry continues to be important in our lives, and for many individuals it continues to be adaptive to exhibit a high level of vigilance.

Like everything in life, moderation is the key. In the same fashion that our bodies can manage changes in temperature, by a process we know as homeostasis, our bodies can cope with different amounts of stress. The body can become overburdened, however, if stress becomes sustained, unrelenting or too severe. We refer to the amount of stress we carry as our allostatic load. If the load becomes too substantial, stress become maladaptive and it interferes with performance, happiness, and health.

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There are steps we can take in improving our stress burden. A key step is to approach the issues at hand. Dealing with concerns that are bothersome require their recognition. If we pretend that something is not stressful, the stress does not get processed and it remains pervasive. Approach is one of the best ways to combat stress. Avoidance helps sustain the stress. Stress feeds on avoidance.

There are two types of avoidance; the first we may call the healthy priority type; (e.g.; “I need to get through the day, I’ll address this issue at the end of the day”), the second we may call the denial type; (e.g.; “this issue is not stressful to me”, when in fact it is). The former is adaptive, the latter is not. These two different types of avoidance are processed differently in the brain; the first requires more cognitive control, the second may not involve the same extent of cortical regions that are crucial for conscious processing.

When the second type of avoidance becomes a mainstay of managing stressful events, our allostatic load increases and in some individuals this avoidance can take the clinical picture known as “dissociation.” Dissociation is a state of consciousness that makes the individual believe that something is not real, or is not really happening. During key developmental stages of life, when “fight or flight” may not be an option because of our size or limitations, dissociation could be an adaptive defense mechanism. When it becomes fixated, however, it may lead to dysfunction in work, relationships, and cause severe distress.

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Dissociation can exist in many modalities. To some extent we have all experienced it. For example, when we arrive home and don’t recall our driving there or when dinner is ready and we don’t remember preparing it. Our consciousness was not in the moment processing our events, we were dissociated. For some individuals dissociation becomes a means to regularly manage stressful events. Stressful events, hence, do not get processed and the individual develops distress. For some individuals the distress is so overwhelming that engaging in self-injurious behaviors (SIB), such as cutting or hair pulling, help them escape that distress, but only temporarily. Dissociation is avoidance on steroids; the antithesis of approach. Areas of our brain located on frontal and temporal regions seem to play a role in dissociation. SIB is a concrete example on how stress does not get processed during dissociation, it then accumulates and becomes overbearing.

Self-injurious behaviors do not work as an adaptive response because, like other addictions, individuals develop tolerance to it requiring the SIB to increase in severity while becoming less effective. Individuals engaged in SIB need professional help, don’t take this on your own. It will be important to address issues of safety, control, avoidance, stress, and anxiety. One should seek professionals trained and dedicated to approach this particular problem. The good news is that treatment works, but the problem needs to be recognized. Once again, if avoided, stress will feed upon it.

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