Toxic Stress: Signs, Causes, & Treatments

Stress is a normal physiological and psychological response to threats, life demands, and difficult circumstances. Normal stress is temporary and situational in nature and tends to resolve itself naturally. Toxic stress is frequent, chronic stress in the absence of adequate support, and has harmful and potentially lasting effects on a person’s physical and mental health.

Signs of Toxic Stress: What It Looks Like

Toxic stress (also called chronic stress) occurs when the brain and body’s fight or flight response is activated too often or for too long. The fight or flight response activates in response to perceived threats, problems, or demands and results in the release of hormones  like adrenaline and cortisol. This response happens naturally in response to difficult or demanding circumstances, but toxic stress normally only develops when there are multiple stress factors that are persistent and severe.

Heightened cortisol levels in toxic stress increases a person’s risk of chronic illness, infections, injuries, mental illnesses and addictive disorders.^1,3,6 Toxic stress can manifest in distinct changes in a person’s physical and mental health as well as affecting their behavior and choices.

These changes are individualized, but some of the more commonly reported signs of toxic stress include:^5,7

• Physical pain or discomfort like headaches, muscle aches, Gastrointestinal upset
• Increased heart rate, blood pressure or respiration
• Sleep disturbances or nightmares
• Changes in appetite, eating, and weight
• Trouble regulating emotions, irritability, anxiety, depression, or mood swings
• Impulsive, risky or destructive behavior patterns
• Increased use of substance or alcohol
• Trouble focusing, concentrating, or remembering things
• Inability to feel present or engaged in activities
• Impaired functioning in one or more area of life
• Social withdrawal or isolation
• Constantly feeling anxious or overwhelmed
• Racing thoughts or negative thoughts about self, life, and future

In children and teens, toxic stress is particularly harmful, interferes with normal development and has the potential to have lasting effects on a person’s physical and mental health.^1,3 Children who do not have a consistent, supportive and nurturing caregiver are especially at risk for toxic stress, as are children who live in abusive, neglectful or otherwise unsafe homes.^2,3 In severe cases, toxic stress in children can lead to abnormal development and permanent structural changes in the brain closely linked to cognitive impairment, severe forms of mental illness and addiction, and a range of chronic health issues.

In addition to the signs and symptoms listed above, some additional ways toxic stress can manifest in children and teens include:^1,2,3

• Dropping grades
• Increase in behavioral outbursts and tantrums
• Reduced interest in social and recreational activities
• Aggressive behaviors or fighting (older kids/teens)
• Increased defiance or rebellion
• Fidgeting, restlessness or trouble sitting still
• Increased separation anxiety (younger children)
• Bedwetting or toileting accidents (younger children)
• Cutting or other forms of self-injury (older kids/teens)

Causes and Triggers of Toxic Stress

Toxic stress typically occurs in response to ongoing stressors or prolonged exposure to adversity. Sometimes the cause of the toxic stress is a specific traumatic event.

Some examples of adverse experiences that can lead to toxic stress include:^1,4,5,7

• Job loss or change in employment status
• Bankruptcy or an unexpected expense/change in financial status
• Being diagnosed with a chronic or terminal illness
• The death of a loved one
• An accident that lead to a serious injury
• Divorce or separation from a significant other
• The ending of an important relationship
• Physical or sexual assault
• Being the victim of a crime
• A traumatic event that affects a family member or loved one
• Natural disasters
• Emotional, physical or sexual abuse

Because toxic stress is chronic in nature, the causes and triggers of toxic stress are usually stressful circumstances and multiple stress factors that persist over a long period of time.

Some of the ongoing stressors and triggers that can contribute to toxic stress include:^1,4,7

• Racial or cultural prejudice and oppression
• Poverty and ongoing financial instability
• Chronic unemployment or underemployment
• Workplace problems and job stress
• Chronic physical and mental health issues
• Family conflict and discord
• Lack of safe, adequate housing
• High exposure to crime
• Being bullied (kids/teens) or harassed
• Having a physical or developmental disability

Risk & Protective Factors

Certain internal and external factors can make it more or less likely that a person will experience toxic stress. Factors that make it more likely that a person will experience toxic stress are called risk factors and factors that make it less likely are called protective factors. Some risk and protective factors are internal and include things like genetics, having an existing physical or mental health condition and a person’s mindset.

Other risk and protective factors are external and include experiences, social connections, and employment status.

Research has helped us identify some of the primary risk and protective factors that influence a person’s likelihood to be affected by toxic stress, and these include:^1,3,4

Physical & Mental Health Effects of Toxic Stress

Toxic or chronic stress is an important topic because researchers have found that it has several serious effects on a person’s physical and mental health. Toxic stress is the result of frequent and prolonged activation of the body’s natural stress response. Also called the “fight or flight” response, this activation begins when the brain detects a threat and activates the sympathetic nervous system.³

When activated, the sympathetic nervous system starts a chemical chain reaction that increases a person’s heart rate, blood pressure, and respiration. Normally, this response will cause temporary changes in the way a person thinks, feels and behaves but will not have lasting effects.

In the case of toxic stress, however, this stress response is occurring too often, resulting in heightened cortisol levels and causing lasting effects on physical and mental health, which may include:^3,4,6

• Weakened immune system & more frequent infections
• Higher rates of chronic illnesses
• Higher rates of mental illnesses
• Poor coping and emotion regulation skills
• Increased vulnerability to substance addictions
• Impairments in memory, learning and thinking

Experiencing adversity and trauma in childhood in the absence of a supportive caregiver can cause a toxic stress response, which is especially detrimental to all aspects of a child’s health and development. When exposed to toxic stress, permanent structural changes can occur in the brain. These structural changes are believed to contribute to a range of lasting emotional, behavioral and mental health issues as well as impairments in learning. ^1,3,4,6

Childhood trauma, adversity, and toxic stress can lead to the following issues in adulthood: ^1,2,3,4,6

• Being in an abusive relationship
• Abusing substances
• Suicide attempts
• Contracting a sexually transmitted infection
• Developing heart disease or liver disease
• Developing chronic illnesses like asthma or auto-immune disorders
• Developing cognitive impairments that affect learning and memory
• Having poorer executive functioning (planning, decision making, etc.)
• Developing destructive habits like gambling or promiscuity

Treatment of Toxic Stress

Toxic stress is a treatable condition, but the treatment is highly individualized to each person and depends on the causes of the stress and the specific ways it is manifesting. Some people who have toxic stress need physical and mental health treatment to control their symptoms, and many also need to access resources that can help to address the source of toxic stress in their lives.

Mental Health Counseling

Mental health counseling can be helpful for people who are experiencing signs of toxic stress. This treatment usually involves weekly group, family or individual therapy sessions with a licensed counselor. Counseling can help people struggling with toxic stress better understand and manage their symptoms by using different methods of coping. Counseling can also support problem solving when the causes of toxic stress are external in nature.

Some people may be in need of more intensive or targeted mental health treatments including:

• Inpatient rehab or detox for substance withdrawal and recovery
• Intensive outpatient groups that meet several days a week
• Medication to treat depression, anxiety or other mental health symptoms
• Employee Assistance Programs (EAPs) are employee benefits offered by some companies and normally include a certain number of free counseling sessions and other wellness benefits that target stress reduction
• Couples counseling or family counseling to address specific conflicts or stressors at home
• Specialized therapy with counselor trained in specific issues like grief, chronic pain, or trauma

Physical Health Treatment

In addition to mental health treatment, treatment may be needed. Medical treatment can be provided by a primary care or specialist physician and is appropriate in situations where the toxic stress is causing physical symptoms or worsening an existing health problem.

Treatment may include prescribed medications, recommended lifestyle changes, or diagnostic procedures. Some of the more common reasons a person with toxic stress would seek care include insomnia, problems with appetite or weight, or other physical stress symptoms like migraines or constipation.

Community Resources and Support

Because toxic stress often occurs in reaction to very real external stressors and demands, many people will need to address the sources of toxic stress in their lives and current circumstances. Some of the resources that people experiencing toxic stress may need to seek out include:

• Parenting resources or childcare
• Vocational education or support
• Affordable housing
• Financial assistance
• Legal aid or representation
• Victim advocacy, support, or crisis centers
• Disaster relief services
• Support groups for issues like divorce, cancer, etc.

How to Get Help for Toxic Stress

There are many entry points for people living with toxic stress seeking professional help. Where a person begins their search is highly dependent upon the circumstances and factors causing the stress and also the specific ways the stress is affecting them.

Examples of getting help for specific types of toxic stress include:

• Primary care doctor: people who are experiencing health problems or physical effects that they believe are stress-related may want to schedule an appointment with their primary care doctor to review their concerns
• Specialty medical care: People who have been diagnosed with a specific chronic health problem or condition that is causing or worsening stress should consider seeing a specialist to help manage their condition. For example, a person with chronic pain may consult with a pain management doctor, and a person recently diagnosed with cancer should see an oncologist.
• Rape crisis center: people who have experienced a recent rape or sexual assault can begin their search by locating the closest rape crisis center
• Department of Health and Human Services (DHHS): People who are experiencing toxic stress resulting from not having their basic immediate needs met would benefit from financial, housing, or food assistance. The process of applying is often started through the HHS.
• Talk therapy: Those who are looking for a therapist to help them manage mental health symptoms or improve coping can begin their search online or by calling their insurance company to ask for a list of in-network providers. Online therapist directories also are an excellent starting place to find a psychotherapist.
• Support groups: Support groups are available in most communities around the nation (and online) and include options for people struggling with a number of issues like addiction, grief, or divorce. Support groups are excellent ways for people struggling with specific issues to connect with others who understand their experience and provide both emotional support and practical advice.

Toxic Stress Statistics

National and societal statistics on toxic stress:⁶

• The US had the highest rates of mental health conditions and second highest rates of substance addictions than any other country in the world
• Compared to 16 developed nations, the US had the worst overall health outcomes
• Compared to 16 developed nations, the US had the highest rates of deaths caused by violence, at almost three times higher than the next country
• Compared to other nations affiliated with the Organization For Economic Cooperation and Development, the US had the highest rates of income inequality
• Compared with 11 other developed nations, the US had the most expensive and least effective health care system

Individual statistics on toxic stress:^6,7

• 60.7% of men and 51.2% of women will experience trauma and toxic stress in their lifetime
• Of those who report experiencing stress:
  • 54% say their relationships have suffered or had more conflict as a result
  • 48% say stress has had a negative personal or professional impact
  • 35% report that the demands of their job or lack of work/life balance was a cause

• Of those who reported stress, the most common physical and psychological effects were:
  • 51% reported fatigue
  • 44% reported headaches
  • 30% reported muscle tension
  • 50% reported irritability or anger
  • 45% reported feeling nervous or anxious
  • 45% reported a lack of energy
  • 35% reported feeling tearful

• The most commonly reported sources of stress in the US are:
  • The future of the nation/politics
  • Job pressure
  • Money and financial strain
  • Health problems or illnesses
  • Relationship issues like divorce, conflict or loneliness
  • Unhealthy lifestyles including poor nutrition and sleep
  • Media overload
  • Violence and crime

Statistics on Children Exposed to Toxic Stress:^5,6,8

• 21.8% of children in the U.S. live in poverty
• In 2018, more than 3.5 million children were the subject of abuse or neglect investigations.
• One study found 96.4% of teens who have had a psychiatric hospitalization have a history of physical, emotional or sexual abuse
• A child who experiences 4 or more traumatic events is 15 times more likely to attempt suicide, 3 times more likely to develop depression, and 4 times more likely to become an alcoholic or IV drug user
• In 2018, 678,000 investigations found proof of abuse or neglect, and of those:
  • 60.8% of these children were neglected
  • 10.7% of these children were physically abused
  • 7% were sexually abused
  • 15% suffered from more than one type of maltreatment
  • 91.7% of victims were maltreated by one or both parents
  • 1,770 children died from the abuse or neglect
• People who experienced 3 or more adverse childhood experiences are up to 30 times more likely to develop a psychotic disorder
• People with a history of child abuse are 3 times more likely to attempt suicide
• People who experience child abuse may be up to 50% more likely to engage in criminal activity

Reducing Toxic Stress: 5 Strategies for Success

Because of the many harmful and lasting effects of toxic stress on a person’s physical and mental health, managing stress should be a priority for everyone. It’s important to remember that not all stress is bad stress. It’s completely normal to experience stress during difficult or demanding times, and at low or moderate levels, stress can even be helpful and motivating. Stress only becomes toxic when it is lasting, severe, and begins to affect your physical and mental health or your ability to function.

Some of the strategies that can help you reduce stress and protect yourself from the harmful effects of toxic stress include: ^1,3,7

1. Focus on Things in Your Control

Toxic stress is often the result of many different stressors and demands, some of which may be beyond your control. Focusing on these will often lead to feeling more stressed and overwhelmed. Instead, try focusing on whatever factors are within your control, even if this is just your response to a situation, your outlook, or what you do in your free time to relax. When it is possible to take action that can improve your situation or address the root issues, investing time and energy into these actions can provide a positive return.

2. Maintain a Healthy and Balanced Lifestyle

When people experience stress, they become much more likely to fall into unhealthy habits like smoking, drinking, overeating, and spending too much time on screens. These unhealthy habits can provide temporary relief from stress but can lead to long-term problems and health issues that can worsen stress. Make your health a priority and do what you can to ensure that you are eating well, sleeping enough, exercising regularly, and avoiding drugs and alcohol.

3. Strengthen and Maintain Your Relationships

The research consistently proves that one of the more protective factors against toxic stress is support from people who care about you. Some people have a tendency to push people away or to isolate when they are stressed out, but isolation only worsens the harmful effects of toxic stress. Make an intentional effort to continue to reach out, respond, and make plans with people who you feel close to.

4. Find relaxation techniques that help you de-stress

There are a number of excellent practices that can help promote relaxation, and making these a part of your normal routine can really help reduce and manage stress.

Examples of relaxation techniques that some people find helpful include:

• Mindfulness practices
• Guided meditations
• Yoga or Tai Chi
• Progressive muscle relaxation
• Body scans and breath awareness exercises
• Visualization exercises

5. Set Goals and Plan for Your Future

When people experience toxic stress, they might have the belief that their situation will never improve which leads them to feel more overwhelmed and hopeless. Goals and plans for the future provide you with direction, purpose and meaning, as well as optimism that your circumstances can improve.

Toxic Stress Tests, Quizzes & Self-Assessment Tools

Toxic stress is not an official medical diagnosis, but rather a term used to describe stress that is severe and chronic in nature. Toxic stress can be identified by reading about signs and symptoms and taking inventories to become more aware of your personal risk factors.

• Learn your ACES and Resilience Score: Take the ACES questionnaire to learn more about how many adverse childhood experiences (traumatic experiences) you had and how these might affect your physical and mental health. Calculate your resilience score to learn more about protective factors that help you cope and reduce your risk of toxic stress and its effects.
• Harvard’s “Toxic Stress 101” page: This site offers many resources, studies, and informational articles on toxic stress.
• The American Institute of Stress offers a free stress assessment, as well as more general facts about stress, its effects, and different sources of stress.