Over 60 years ago, Selye1 recognized the paradox that the physiologic systems activated by stress can not only protect and restore but also damage the body. What links these seemingly contradictory roles? How does stress influence the pathogenesis of disease, and what accounts for the variation in vulnerability to stress-related diseases among people with similar life experiences? How can stress-induced damage be quantified? These and many other questions still challenge investigators. This article reviews the long-term effect of the physiologic response to stress, which I refer to as allostatic load.2 Allostasis — the ability to achieve stability through change3 — . . .

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Protective and Damaging Effects of Stress Mediators

Two hundred and thirty-five adolescents completed a questionnaire on the subject of eating attitudes, self-esteem, reasons for exercise, and their ideal versus current body size and shape. As predicted, boys were as likely to want to be heavier as lighter, whereas very few girls desired to be heavier. Only girls associated body dissatisfaction with the concept of self-esteem. Male self-esteem was not affected by body dissatisfaction. Specific reasons for exercise were found to correlate with low self-esteem and disordered eating, regardless of sex. The results are discussed in relation to burgeoning published research in this area.

http://www.csub.edu/~lhecht/Classes/BEHS501/Articles/BodyImage.pdf

Body image dissatisfaction: Gender differences in eating attitudes, self-esteem, and reasons for exercise

Gout

Stress, Health, and the Social Environment

Mental disorders are of major public health significance. It has been claimed that vigorous physical activity has positive effects on mental health in both clinical and nonclinical populations. This paper reviews the evidence for this claim and provides recommendations for future studies. The strongest evidence suggests that physical activity and exercise probably alleviate some symptoms associated with mild to moderate depression. The evidence also suggests that physical activity and exercise might provide a beneficial adjunct for alcoholism and substance abuse programs; improve self-image, social skills, and cognitive functioning; reduce the symptoms of anxiety; and alter aspects of coronary-prone (Type A) behavior and physiological response to stressors. The effects of physical activity and exercise on mental disorders, such as schizophrenia, and other aspects of mental health are not known. Negative psychological effects from exercise have also been reported. Recommendations for further research on the effects of physical activity and exercise on mental health are made.

The relation of physical activity and exercise to mental health.

We studied cortisol secretion and metabolism in 10 women with anorexia nervosa. The 24-hour mean plasma cortisol concentration was 8.9 mug per deciliter (controls, 4.9) (P less than 0.01). Secretory patterns showed normal circadian rhythms. Cortisol half-life was prolonged from 60 to 78 minutes (P less than 0.01), and metabolic clearance rate was decreased from 359 to 177 liters per day (P less than 0.001). Cortisol production was normal (19.4 mg per day). Urinary cortisol was slightly elevated in two of five patients. These findings, as well as the increased tetrahydrocortisol/tetrahydrocortisone ratio (1.2 vs 0.65, P less than 0.01), also appear in hypothyroid patients. Thyroid-function studies showed normal total and free thyroxine and thyrotropin, but low plasma tri-iodothyronine levels (52.7+/-13.2 vs. 137.8+/-24.1 ng per deciliter in the controls, P less than 0.001). In five additional patients with anorexia nervosa studied before and after short-term tri-iodothyronine administration, metabolic abnormalities decreased as plasma tri-iodothyronine levels rose to or above normal.

Cortisol Secretion and Metabolism in Anorexia Nervosa

Hyperactivity in anorexia nervosa: A fundamental clinical feature

Long-distance running, anorexia nervosa, and bulimia: A report of two cases

25 unselected women with operable breast cancer were followed after radical mastectomy until they died of recurrent cancer (non-survivors), or for 10 years if there was no recurrence (survivors): all the women still alive at 10 years were clinically and radiographically disease-free. Survivors and non-survivors were compared with respect to premastectomy height, and deviation from ideal weight. There were 16 women in the survivor group; at the time of mastectomy, they averaged 11% above ideal weight and only 4 of them (25%) were obese (20% or more above ideal weight). There were 9 women in the non-survival group; they averaged 51% above ideal weight at the time of mastectomy and all of them were obese, as defined. The intergroup difference in mean deviation from ideal weight was very highly significant (P less than 0.0001). Of the 13 women who were obese at mastectomy, only 4 (31%) became survivors, while 100% of the 12 women who were non-obese at mastectomy became survivors; the difference in percent survival was very highly significant (P less than 0.005). Separate evaluation of the roles of height and weight showed that height was not a factor and weight accounted entirely for the observed differences. It appears that maintenance of nonobesity may be a more effective way of decreasing mortality from breast cancer than any other measure proposed to date.

Nonobesity at the time of mastectomy is highly predictive of 10-year disease-free survival in women with breast cancer.

Eleven women with the polycystic ovary syndrome (POS) were interviewed prior to treatment to assess psychosexual and behavioral characteristics. Because the polycystic ovary syndrome is characterized by an elevated plasma level of free testosterone that presumably develops after birth, we examined specifically the six areas traditionally explored in prenatally androgenized women — play preference, energy expenditure level, interest in dress and appearance, career vs. family preference, sexual arousal to narrative and visual stimuli, and sexual initiative. While these women described patterns in all categories similar to those reported in the earlier studies of prenatally androgenized women, their behavior was significantly different only in sexual initiative from that of two normal control groups. These findings suggest that increased sexual initiative may be a heretofore unemphasized clinical feature of the polycystic ovary syndrome and conceivably a concomitant of elevated free plasma testosterone.

Jack L. Katz

Papers

Cortisol Secretion and Metabolism in Anorexia Nervosa

Hyperactivity in anorexia nervosa: A fundamental clinical feature

Long-distance running, anorexia nervosa, and bulimia: A report of two cases

Nonobesity at the time of mastectomy is highly predictive of 10-year disease-free survival in women with breast cancer.

The polycystic ovary syndrome:psychosexual correlates.