Difference Between Stress and Anxiety: Does it Matter?
Rachel Sykes | I Work with Stressed Out Professional Women | Licensed in Massachusetts
Rachel C. Sykes, LMHC, LLC
Rachel@rachelcsykes.com
rachelcsykes.com
I recently had a someone tell me that it looked like my specialty was helping clients with stress but not with anxiety, which was different. I thought it might be helpful to share my take on the differences and similarities and possible reasons that it matters.
Stress and Anxiety
Stress and anxiety tend to have similar if not identical characteristics – sufferers experience symptoms such as worry, perseveration, overwhelm, reduced energy level, heart racing, difficulty sleeping, physical shaking, muscular tension, changes in blood sugar levels, decreased immunity, and even ulcers. One does not have to have all or even most of these symptoms but these are ones I am aware of. That all sounds pretty unpleasant.
stressed out
Persistent: Chronic vs. Short-Term
One of the major differences between these two conditions is that stress is usually triggered by some external pressure such as a new job, relationship problems, financial worries, bad news, etc., whereas anxiety is a long-term ongoing condition that is not prompted by a stressor or stressors. Anxiety can manifest when a person is a child, and be present to varying degrees each day but it rarely seems to go away on its own. Anxiety may certainly worsen due to external (or internal) pressures but those pressures are not the primary cause of the problem.
Proportionate or Disproportionate?
According to the official diagnostic guide for psychological conditions (DSM-V-TR), one key requirement for a formal diagnosis of an anxiety-related condition is that the symptoms are disproportionate to the circumstances. What does that mean? Well, you have to use judgment here but if it seems normal for an individual to be distraught under certain circumstances, it is likely to be stress. If the person’s symptoms seem excessive for the situation, it is more likely to be considered anxiety. Again, stress is not fun but it is not necessarily a formal mental health disorder.
Impacts Multiple Areas of Life
Sometimes, a particular area of our lives can be problematic. Consider Clara, a generally well-adjusted person who has been having a tough time at work. She is extremely worried about losing her job and her worry seems to be making things worse. However, she is reasonably happy and well-functioning at home and with friends. Clara’s ability to cope well in some areas of life indicates that her overall functioning may not be clinically impaired. This is therefore more likely to be stress rather than anxiety. If instead Clara’s worries are damaging her friendships and alienating her family members, it is more likely to be anxiety. Get it?
Quiz
Try to make the determination yourself in the following examples:
Example 1
Meredith got a new job as an insurance specialist that pays about 20% more than her last position with similar responsibilities. She was really excited about this new position and the opportunity it represents. In anticipation of making more money, she moved into her own apartment—the first time she has lived independently. She started her new job about two months ago and was shocked to find out that she is expected to “provide coverage” during the evenings and weekends in addition to her full-time hours during the week, and that she will only receive this higher pay level if she completes a lot of work in her off-time. She discussed this with her boss and it seemed to make the situation worse. Meredith doesn’t believe she can find another position or return to her last job right now, and she really depends on her paycheck for her monthly expenses. Meredith has difficulty sleeping, concentrating, and is dealing with near-constant worry. She is experiencing stiffness in her shoulders and has some pain in her stomach. This experience is pretty new for her; she has been able to handle other transitions with relative ease but this time, it feels different. She has been spending time with two of her close friends who have been really supportive.
Stress or anxiety?
Onset of symptoms: about 2 months
Identifiable stressor? yes-new job
Proportionate to circumstances? IMO, yes
Impacts multiple areas of life? there is no evidence of this
My opinion: Stress
Example 2
Your friend Lucy is telling you about her 27-year-old son Chase. Lucy talks about him all the time, as she is concerned that he struggling to succeed at work and that he seems unlikely to move out of Lucy’s home any time soon. Chase was told that he was on a performance plan at his new job, as he is failing to meet expectations due in part to his high absenteeism. Chase frequently has a couple days a week where he sleeps through his alarm clock because he had trouble falling asleep the night before. He describes the problem as “whirlwind” of thoughts in his head, where he “spirals” on worrisome thoughts for hours and has trouble settling down. He has experienced these bouts of worry since he was in elementary school, where he was worried about his homework, his teachers, and the other children. Chase has always tested well, as he is quite bright, but his school performance was mixed, as he often lost points on his assignments due to missing the deadline. While he has some friends, they sometimes lose patience with his failure to follow through with plans. “He’s having the same problems now as an adult except now they are putting yet another job at risk,” says Lucy.
Stress or anxiety?
Onset of symptoms: since elementary school
Identifiable stressor? not really
Proportionate to circumstances? IMO, no
Impacts multiple areas of life? yes: home, work, school
My opinion: Anxiety*
Stress is Bad Enough
Regardless of whether or not one is anxious or just stressed, many of the symptoms are the same and are difficult to manage. For people who have existing mental health issues, additional stress can make them worse. Furthermore, mental health considerations can be stressful in and of themselves. In fact, stress is believed to weaken immunity and increase the likelihood of getting sick. Some of the factors that affect one’s ability to deal with stress include social supports, coping style, and even genetics, and consequently have biological impacts on mental and bodily functioning.
Anxiety or Stress: Does it matter?
To some extent, I don’t think it matters too much. As mentioned above, the symptoms of stress and anxiety are pretty much the same, and some of the ways to manage these symptoms are the same. However, chronic anxiety may have more complex contributing factors that may sometimes stem back to childhood. These influences may be environmental, biological, or both and I am not equipped to end the ongoing nature versus nurture debate.
Anxiety or Stress?
One practical consideration, however, is that anxiety, such as social anxiety or generalized anxiety, are diagnosable mental health disorders and there is a greater chance that those seeking treatment will be covered by many standard health insurance policies. Since stress is considered shorter-term in nature, driven by a specific trigger, is proportionate to the situation, and does not necessarily disrupt functioning in multiple areas of life, it can be more difficult to get mental health treatment covered by health insurance (there are other diagnoses that may warrant coverage but that falls outside the scope of this post). One might argue that difficulty dealing with stress can be a chronic problem that can be successfully addressed in therapy in order to improve one’s ability to cope with stress going forward but that doesn’t technically rise to the level of the formal diagnostic criteria.
Treatment ideas
I don’t think reading a short blog about stress and anxiety qualifies as mental health treatment but I offer a few general suggestions for ways to cope with stress and anxiety.
1. Engage in pragmatic coping techniques to reduce amount of time spent in distress, including:
Breathing exercises
Journaling
Visualization exercises
Engaging the senses
Changing your thinking behaviors
2. Implement regular practices to reduce the frequency of symptoms
take a walk
Make some changes in your routine by exercising daily by taking walks, practicing yoga, weightlifting, or whatever other healthy exercise program works for you. Consider your food choices: are you eating food that makes you feel good, feel energized during the day and and help you sleep at night? Can you change your sleep routine so that you are more relaxed and restful at bed time? Can you make weekly plans to spend time with good friends or find ways to meet new good friends?
3. Determine what stress/anxiety is trying to tell you – is there a disconnect?
I realize that a stress or anxiety response is not an enjoyable experience but sometimes I think of it as your mind and body’s way of bringing attention to a problem. I think it can often be viewed as something in your life that feels off or disconnected. Sometimes, these bells are ringing for reasons that may not seem on the surface to make logical sense but there is usually something to be learned there.
4. Rewrite your story – beliefs, identity, priorities, thoughts and behaviors
To really get to the core of anxiety, you may have to do more than engage in coping exercises and take more walks. Essentially, I see that people have underlying beliefs about self and the world that increase one’s experience with stress and anxiety (and depression, for that matter). Once you have identified some of your underlying beliefs, you may recognize that there is an opportunity to update your beliefs to reflect the life experience you have gained over time. There are some great techniques and theories to do this work, such as rewriting your own story (a type of Narrative Therapy) or by using Cognitive Behavioral Therapy to change your thoughts, feelings and behaviors. Find a good book or talk to a trained professional!
Contact Me
Questions? Check out my website, request an appointment or call/email to ask for a free 15-minute consultation.
Resources
What is stress? March, 2022. Mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/what-is-stress/#:~:text=Stress%20is%20not%20normally%20considered, can%20make%20existing%20problems%20worse.
Salleh MR. Life event, stress and illness. Malays J Med Sci. 2008 Oct;15(4):9-18. PMID: 22589633; PMCID: PMC3341916. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341916/
These vignettes are illustrative in nature. It is not appropriate to make a formal diagnosis based on a description or story told by a third party. If you are concerned that you or a loved one is suffering from a mental illness, please seek a consultation from a trained professional.