Stressed To Kill

Research shows we perform more productively at optimal levels of stress. Unfortunately, these days many of us of see this as permission to take on too much and work too hard. This can push our stress levels too high and damage our health. But, how much stress is too much? And what can you do to manage your stress effectively?

In the 21st century, being stressed is regarded as a status symbol - if we are not stressed then something is wrong!

We seem to have lost the plot - it's not OK to be stressed! Excess stress is detrimental to our well-being and causes decreased productivity. Both individuals and organisations suffer.

What is Stress?

Stress occurs when a person perceives the demands of an event or situation to be too much for them. In other words, people feel stressed when they believe they can't cope.

Feeling stressed has little to do with the actual cause of the stress. It is more about our perception of a situation. Something may only be experienced as stressful if we evaluate it as such. What is overwhelming, threatening, unsatisfying or conflictual for one person may be mildly challenging or even exciting for another.

The degree of stress we experience depends on a combination of factors:

  1. How important the event is to us; and
  2. Our level of uncertainty about our ability to deal with the event.

For example: Starting a new job is likely to be very stressful if you feel inexperienced, unable to cope with the workload and uncomfortable around your bosses and colleagues. On the other hand, if you start a job where you feel competent and supported by your colleagues, you are far more likely to feel challenged and excited rather than 'stressed out'.

"If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it;
and this you have the power to revoke at any moment."

Marcus Aurelius

Common Causes of Stress

As mentioned above, the way a person evaluates an event or situation is the most important component of stress, but there are a number of things that are generally considered to be common causes of stress.

Top Ten Stressors

1. Change (adaption)
Any event that involves change or adaption - even celebrated events like marriage, birth, Christmas or moving home – can be stressful. Many studies show the correlation between life changes, stress and illness.

2. Daily Hassles
Many researchers argue that these contribute more to illness and psychological disturbance than major life changes.

3. Frustration
Seemingly innocuous, but bothersome and unavoidable events that cause frustration can send stress levels soaring.

4. Overload
Overload occurs in both private and professional lives. Doing too much – in too little time – is definitely stressful!

5. Deprivation
Boredom and deprivation can be distressing. Lack of food, shelter, money and other resources all have an impact on mental and psychological health. Emotional deprivation and lack of caring or attention can have a particularly profound effect on the health and well-being of both children and adults. Feelings of loneliness and alienation can be particularly stressful. 

6. Nutrition
Eating incorrectly places incredible strain on the body by depriving it of essential nutrients, vitamins and minerals. This leaves the body vulnerable to the ravaging consequences of stress. Stimulants like cigarettes (nicotine) and caffeine heighten stress reactivity and are toxic to our systems. A healthy, balanced diet protects us against stress and enhances our immune system.

7. Noise
Research has shown that people who live in high noise areas such as living close to airports, freeways, train lines, clubs and pubs have higher stress levels than those living in quiet areas.

8. Self-perception
Concerns over self-image and self-worth can manifest themselves in range of psychological disorders – anorexia, bulimia, anxiety, alcoholism, substance abuse and even major depression. People who do not have an intrinsic sense of control or personal responsibility (i.e. who do not feel they are able to make changes in their environment) are generally more stressed than people who feel they have control.

9. Type-A - personality
The type–A person is driven, conscientious, aggressive, ambitious, competitive, shows an over commitment to work and productivity, is filled with a sense of time urgency and impatience, multi-tasks, has poor relationships and little concern for others. The relationship between the type-A behaviour and stress is well documented. Type–A personalities are also 'stress-spreaders', increasing the level of stress experienced by those around them.

10. Anxious reactivity
People who make mountains out of molehills tend to be stressed.

Other Stressors

Poor Social Skills
When people cannot interact with others freely and easily it is very stressful, because all spheres of life require us to engage with others. Worrying about what to say, when to say it and how to say it is very stressful.

Lacking assertiveness
When we cannot ask for what we want, or say no to something we are uncomfortable with, it can be very stressful. Assertive individuals know how to ask for what they want, or say no to what they don't want, in a way that is clear, open, honest and respectful. They may not always get their own way, but others will know exactly where they stand and there will be no tension, animosity or resentment. 

How Vulnerable are you to Stress? Take the Test

A Self-Evaluation Test

The following test has been adapted from a test developed by Lyle Miller and Alma Dell Smith, psychologists from the Boston University Medical Centre.

To measure your potential vulnerability to stress, you need to score each item from 1 (almost always) to 5 (never), according to how much of the time each statement applies to you.

ItemScore (1 - 5)
 I eat at least one, hot, balanced meal a day.  
 I get seven to eight hours sleep at least five nights a week.


 I give and receive affection regularly.


I have at least one relative within 50 kilometres on whom I can rely.


 I exercise to the point of perspiration at least three times a week.


 I smoke less than five cigarettes a day.


 I take fewer than five alcoholic drinks a week.


 I am within appropriate weight range for my height.


 I have an income adequate to meet my basic expenses.


 I get strength from my religious/spiritual/cultural beliefs or values.


 I regularly attend club, sport or social activities.


 I have a reliable network of friends and acquaintances.


 I have one or more friends to confide in about personal matters.


 I am in good health.


 I am able to speak openly about my feelings when angry or worried.


 I do something for fun at least once a week.


 I am able to organise my time effectively.


 I drink fewer than three cups of coffee (or tea or cold drinks) a day.


 I take quiet time for myself during the day.


 I have regular (non-conflictual) conversations with the people I live with about domestic
 problems, e.g. chores, money and daily living issues.




Add up the scores.
Any total over 50 indicates a vulnerability to stress.
You are seriously vulnerable if your score is between 70 and 90.
You are extremely vulnerable if over 90. In this case you may want to seek urgent help from a psychologist or medical practitioner.

How Stress Works

The process of readying the body to cope with a threat begins with the senses. For thousands of years, the bodies of cavemen and women were primed to deal with the harsh physical rigours of their environment. Their senses were well tuned to instantly pick up dangers, and in the face of such danger, a rush of adrenalin would prepare cave dwellers to deal with it - they would either face the danger ('fight') or run for their lives ('flight').

Thousands of years later, humans live in the same bodies and possess the same brains, but live in a world with completely different stressors. While few humans still face the danger of wild animals, modern, urban life is equally demanding. The urban environment is rife with stressors, such as violence, traffic, noise, work demands etc that stimulate the nervous system into a fight - or - flight response, but it is only in rare instances that an aggressive or vigorous physical response is appropriate.

"We live longer than our forefathers; but we suffer more from a thousand artificial anxieties and cares.

They fatigued only the muscles, we exhaust the finer strength of the nerves."

Edward George Bulwer-Lytton

In the face of adversity, powerful hormones epinephrine and norepinephrine (also known as adrenalin and nor-adrenalin), are released by the adrenal glands causing enhanced alertness, strength and energy. Muscles and nerves are charged for sudden movement, heart rates increase, blood courses through our veins and sugar is released into the bloodstream.

Humans detect a danger or threat via the senses – we see, hear, smell, feel or even taste danger. This message is transmitted to the brain. The hypothalamus in the brain then activates the Autonomic Nervous System and the Endocrine system.

The Endocrine system includes all the glands that secrete hormones:

  • Thyroid gland (found in neck);

  • Pituitary gland (found in brain);

  • Adrenal gland (found on top of kidney).

It is the adrenal gland that is important when it comes to stress, because it secretes the hormones for our fight or flight responses.

The Adrenal gland consists of the:

  • Adrenal Cortex – releases Cortisol which provides fuel for battle and increases blood sugar and blood pressure. However, it also decreases the effectiveness of the immune system, so we are more likely to get ill.

  • Adrenal Medulla - releases adrenalin and nor-adrenalin (also known as epinephrine & norepinephrine)

Autonomic Nervous System controls the involuntary functions of the body (temperature, hormone balance, constriction & dilation of blood vessels, heart rate, blood pressure, respiratory rate and body fluid regulation). It is made up of the Sympathetic Nervous System and the Parasympathetic Nervous System.

Sympathetic Nervous System is activated during stress and expends energy. For example, it increases the heart rate. (In other words it responds in sympathy to your situation of stress and assists you to deal with the stress).

When activated by the hypothalamus, via the adrenal gland, the Sympathetic Nervous System does the following:

  • Increases heart rate
    An accelerated heart rate gets the blood flowing around the body more quickly to get the oxygen around the body faster.

  • Increases the force with which the heart contracts
    Increased blood pressure (the force at which the blood is pumped out of the heart) helps move the blood quickly.

  • Dilates coronary arteries
    Blood vessels of the heart become wider to get the oxygen moving more quickly. 

  • Constricts abdominal arteries

  • Dilates pupils
    Larger pupils enable us to see better.

  • Dilates bronchial tubes
    The tubes through which our air passes to and from the lungs become wider so that we can get oxygen into & out of our lungs more quickly.

  • Increases strength of skeletal muscles

  • Releases glucose from liver
    Increased blood sugar is required for energy.

  • Increases mental activity

  • Dilates arterioles deep in skeletal muscles
    Wider blood vessels in the muscles enable oxygen and sugar to get to the muscles more quickly.

  • Significantly increases basal metabolic rate
    Most body processes speed up.

  • Constricts blood vessels in the muscles and skin of the arms and legs
    Narrowing of the blood vessels means less loss of blood in the event of an injury to the arms or legs.

  • Increases oxygen consumption

Parasympathetic Nervous System is activated during relaxation and conserves energy. For example, it decreases the heart rate. (Think of a parachute – it slows you down and brings you gently to the ground). It is responsible for returning us to a relaxed state once the stressor has passed.

Effects of Stress

In the 21st century to be stressed is almost regarded as a status symbol. Today, when we greet someone and ask how they are the reply is frequently, "stressed". Ask after their work and the response is, "stressful". It has almost become the case that if we are not stressed then something is wrong!

Somewhere along the line we have lost the plot, because it is not ok to be stressed. Excess stress (distress or 'bad stress') is harmful, destructive and detrimental to human wellbeing by causing dysfunction or disruption in multiple areas. This disruption extends into our world of work and leads to decreased productivity. Both individuals and organisations suffer.

Scientists and medical practitioners agree that the accumulation of stress products in the body over a prolonged period of time can be devastating on the body and mind. Chronic (long-term) stress will reduce a person's overall physical, mental and spiritual wellbeing. An overload of stress reduces effectiveness and is highly immune–suppressive. In short, excess stress makes us less effective and less efficient.

The effects of stress fall into 4 categories:

1. Physical Effects

Physical effects begin in the brain and spread to organs around the body. Catecholamines from the adrenal medulla cause the kidneys to raise blood pressure and the liver to release sugar into the blood stream.

The pituitary gland stimulates the release of corticosteroids, which help to resist stress but, if left in the system for a prolonged period of time, suppress the immune system.

Prolonged exposure to stress has profound and detrimental effects on health. Among the possible complications that stress may exacerbate or play a role in causing are: asthma, amenorrhoea (absence or stopping of menstrual periods), coronary heart disease, chest and back pains, diarrhoea, indigestion, headaches, migraines, insomnia, diabetes, ulcers, decreased libido and erectile dysfunction, loss of hair, skin conditions.

Stress also:

  • Affects skin’s temperature (gets cold and clammy);

  • Affects skin’s ability to conduct electrical impulses;

  • Causes skeletal muscles to contract causing tension headaches, backaches and fatigue;

  • Decreases amount of saliva in mouth;

  • Causes contractions of the oesophagus, making swallowing difficult;

  • Causes greater secretions of hydrochloric acid, which can result in ulcers.

In a world where AIDS is frighteningly prevalent, we need to be aware that stress suppresses and breaks down our immune system, just as HIV breaks down the immune system, leaving us vulnerable to potentially fatal infections and diseases.

2. Cognitive and Psychological Effects

Stress affects our thought processes, leading to difficulty or fear of making decisions, forgetfulness, hypersensitivity, mental blocks and difficulty thinking or concentrating clearly. This may be intensified by substance abuse.

The most extreme effect of stress is possibly Burnout. Refer to my article Spurn the Burn for more information.

3. Behavioural Effects

Stress can lead to accident proneness, impaired speech, substance abuse, restlessness, forgetfulness and impaired performance.

4. Organisational Effects

The effects of stress on individuals are likely to reverberate throughout the organisation for which they work. Stress leads to high absenteeism and, through its impact on individual workers, to reduced productivity.

In organisations where stress levels are high, there is likely to be growing dissatisfaction and resentment from workers as well as a high labour turnover. Stress causes agitation, annoyance and aggression, which in turn lead to poor industrial relations and conflict between employees.

Excessive stress causes forgetfulness and diminished concentration, which in turn increases carelessness. Accident rates have been shown to rise in organisations where stress levels are too high.

In the long-term, the effects of stress on an organisation will be extremely costly. It is more economical for an organisation to take preventative measures than to try to deal with its effects.

The costs of stress to an organisation include:

  • Lost workdays
  • Hospitalisation
  • Outpatient care
  • Providing psychiatric counselling and care
  • Down time due to accidents
  • Litigation
  • Staff turnover
  • Reduced performance
  • Muted creativity
  • Lack of motivation
  • Loss of morale
  • Sabotage and theft

Stress and Human Effectiveness

An inverted U-type curve has been used to depict the effect stress has on performance. It can be shown that, as stress increases, so does performance and efficiency. However, if stress continues to increase beyond an optimal point (the joy of stress), performance starts to decline (too much stress).

This shows that some stress is necessary to enhance performance. This positive stress is sometimes called 'Eustress'. Once it reaches a level of acute discomfort, however, it is harmful and counterproductive. This is what we refer to as 'Dystress' or distress.

Stress Graph_1 stresscurve
The relationship between the amount of
stress and human efficiency
The same graph, viewed with
a little humour...

Click on each image for a larger view

Recognising the Symptoms of Stress

Stress manifests in our body (physical reactions), in our thoughts and emotions (cognitive and psychological reactions) and in our actions (behavioural reactions). You can diagnose if you are suffering from stress by becoming aware of these reactions.

Read through the list of stress symptoms below and tick the symptoms that you are currently experiencing....

Stress Diagnostic

Physical ReactionsCognitive & Psychological ReactionsBehavioural Reactions


  • Loss of sex drive

  • Sexual problems e.g. erectile dysfunction in men

  • Frequent unexplained headaches / pain

  • Chest pains / heart palpitations

  • Muscle tension – e.g. stiff neck, back, hips

  • Unexplained nausea

  • Frequent heartburn

  • Frequent indigestion

  • Erratic bowel function / diarrhoea

  • Knots or butterflies in stomach

  • Frequent need to urinate

  • Excessive perspiration for no reason

  • Dizzy spells for no reason

  • Feeling faint or unusually weak for no reason

  • Breathlessness for no reason

  • Feeling tight-chested for no reason

  • Erratic periods in women

  • Proness to catch colds and other illnesses easily

  • Skin disorders

  • Ulcers

  • Loss of hair

  • Feeling run down

  • Loss or increase in appetite


  • Feeling tense and wound up

  • Racing mind and thoughts

  • Worrying

  • Panicky feelings

  • Feelings of general anxiousness

  • Phobias (irrational fears)

  • Being afraid of disease

  • Being upset by disease in others

  • An increase in complaints about what happens to you.

  • Apathy / lack of enthusiasm

  • Feelings of helplessness

  • Persistent guilt

  • Feelings of depression

  • Feelings of confusion

  • Feeling that no one understands you

  • Feelings of loneliness and having no one to talk to

  • Feeling that you have failed in your role as spouse / parent/ child / employee

  • Feeling that people are gossiping about you

  • Feeling that no one want to work with you

  • Feeling that other people dislike you

  • Disinterest in other people

  • Feelings of frequent criticism

  • Feeling that you have been neglected or let down

  • Feeling that your appearance has altered for the worst

  • Feeling you can’t cope

  • Feelings of disliking yourself

  • Low self-esteem / low opinion of yourself

  • Lack of self-confidence

  • Feeling that you are a failure

  • Being overly self-critical

  • Feeling disgruntled / moody / irritable

  • Low interest in work

  • A lack of interest in life


  • Difficulty in relaxing

  • Fidgeting / restlessness

  • Memory loss / forgetfulness

  • Poor long term planning

  • Poor concentration

  • Difficulty making decisions

  • Poor time management

  • Inability to meet deadlines

  • Making unnecessary mistakes

  • Procrastination

  • Poor problem solving

  • Poor work quality

  • Difficulty in completing one task before rushing to the next

  • A drop in personal standards and grooming

  • The need to constantly take work home

  • The need to cancel leave

  • Engaging in frequent criticism of others

  • Uncooperative relationships

  • Social withdrawal

  • Increased aggressiveness

  • Difficulty in showing / expressing your true feelings

  • Suppressed or unexpressed anger

  • Sleep disturbances

  • Tearful (for no apparent reason)

  • Ticks / nervous habits

  • Greater use of substances to cope (alcohol, caffeine, nicotine, medicines)

  • Nail biting

  • Difficulty in showing / expressing your true feelings

  • Little sense of humour

  • Emotional outbursts

  • Accident proneness

  • Frantic bursts of energy (initial hyper energy followed by slowing)

If you have ticked any of the above you may be experiencing more than a healthy degree of stress.

Please note: It is not the number of symptoms that counts, so much as the severity – the more severe the symptom, the more stressed you are.

Stress Busters

Short Term, On-the-Spot Exercises

Breathe Deeply
When we are tense, we tend to breathe shallowly. This causes two things to happen: Firstly, we don't get enough oxygen circulating in our body, so we struggle to concentrate and stay alert. Secondly, the carbon dioxide is not fully breathed out, and so builds up in the body, resulting in feelings and symptoms of anxiety and panic.

These two things act together in a vicious cycle which spins us into ever deeper levels of stress. The way to break this cycle is to breathe deeply. Do this as follows:

  • Scan your body. Note where you are tense.

  • Take a deep breath through your nose. Filling up your lungs to the count of at least 5 (or more if you can). Keep your shoulders still, let your stomach do the expanding. This shows that you are breathing into the lower part of your lungs.

  • Hold your breath until it feels slightly uncomfortable. Your intention is to slow down your breathing as much as you can.

  • Let the air out slowly through your mouth. Empty your lungs to the count of at least 10 (try to double the count you breathed in). Exhale fully. It is important that your 'out' breath is much slower than you 'in' breath, as this is what calms you down.

  • Do this twice more.

  • Take another deep breath and let it out.

  • Scan yourself again, checking to see how much more relaxed you feel.

The value of this exercise is that it is extremely effective, can be done anywhere and no one else needs even know that you are doing it.

When we are under stress, our muscles become tense and tight. Over time, these tight muscles drain energy and become very uncomfortable. Some muscles even tighten up so much that they can pull the human skeleton out of alignment if they are not regularly stretched. Doing some simple stretching exercises can increase your energy and your comfort.

Important points to note when stretching:

  • All stretches should be accompanied by slow deep breaths. These oxygenate and relax the body.

  • Breathe in through the nostrils and out through the mouth.

  • Pause in a natural way at the start of the breath, and at the end of the breath.

  • Ensure that your belly button rises and falls – this shows that you are breathing into the lower part of your lungs.

  • Hold all stretches for at least 20 seconds, otherwise they will have little benefit.

  • If you have had any injuries in the area of a stretch, do not stretch that area without medical opinion.

Some suggested stretches:

  • Windmill both arms backwards.
  • Shoulder shrug backwards.
  • Rub hands together to make them warm and then knead the muscles of your neck like dough.
  • Press your hand against the front, back and both sides of your head. Each time press your head against your hand firmly for 10 seconds. This releases tension in your neck.
  • Hip rotations.
  • Sideways stretch.
  • Calf stretches.
  • Hamstring stretches.

Reduce muscle tension
To help you reduce tension in your body do the following exercise.

Scan your body...

  • Can you drop your shoulders? If so, your muscles were unnecessarily raising them.

  • Are your forearm muscles able to relax more? If so, you were unnecessarily tensing them.

  • Is your body seated in a position in which you appear about to do something active? If so, your muscles are probably unnecessarily contracted.

  • Can your forehead relax more? If so, you were tensing those muscles for no useful purpose.

  • Check your stomach, buttocks, thigh and calf muscles. Are they contracted more than is needed?

Unnecessary muscular contraction is called bracing. Many of us are guilty of bracing and suffer from tension headaches, neck aches or back aches as a result. Take a moment to let as many of your muscles relax as possible.

Medium- to Long-Term Stress Busters

Change your attitude towards stress
Choose to think about so called 'stressful' events and situations as 'exciting challenges'. Consider how your thoughts are manifesting themselves in the real world.

Distinguish between stress you can do something about, and stress that is unavoidable
Worrying about things you are helpless to change is incredibly draining. Take action or move on. If you can't do anything about a situation, release it. (If you can't fight or flee, then flow!)

Take one day at a time
Don't dwell on future problems – they may never happen.

In worrying about the destination, don't ignore the journey
People worry so often about finishing a project that they forget why they undertook it in the first place. See life in the act of creation. It is in the journey that we find ourselves.

Develop a forgiving attitude
Most people are doing the best they can. Bitterness and holding grudges cause stress.

Get perspective on your life
There will always be people better off than you and there will always be people worst off than you.

Every night before bed, think of one thing you are grateful for that you have never been grateful for before
Think about writing these things into a notebook so you can read them when you are feeling down.

Take pride in achievement but throw perfectionism out of the window
Seeking perfection only serves to frustrate. People are only human.

Slow down
Don't drive yourself too hard.

Pace yourself
Spread out big changes and difficult projects over time; don't lump the hard things all together

Learn to delegate
If you have too much to do, consider whether this is self-imposed.

Plan & Organise

  • Have a place for everything to avoid the stress of looking for things.

  • Simplify and declutter your life.

  • Allow extra time to do things and get to places.

  • Have back ups like an extra house key hidden somewhere; a snack bar in your bag; money to recharge your phone, for a taxi etc.

Live within your budget

Carry study notes/a paperback/magazine with you to read while waiting for lifts, in traffic jams, queues etc.

Learn how to be assertive. 
This enables you to clearly express your wishes without causing tension between yourself and others. Say 'no' to projects that won't fit into your time schedule, or will compromise your mental health.

Improve your social skills
Interacting with others will then come easily and be stress-free.

Make friends
Open yourself up to making new friends. A friend is someone who makes you feel honoured and loved. Be there for your friends when they are down in the dumps, but let go of so-called friends who are always down and never there for you. Stay away from negative people.

Look for alternatives
When a problem is really getting you down, sit down and consider your options. Join a support group and/or see a counsellor. Try to nip problems in the bud.

Practise "KYMS"
Keeping Your Mouth Shut! This single piece of advice can prevent an enormous amount of trouble. Talk less, listen more.

Eat Right
A healthy, balanced diet protects against stress and is immune enhancing. The less the body is burdened with sugar, fat and processed foods, the less energy it takes to get rid of them.

  • Try to avoid caffeine and sugar. They will increase your levels of stress.

  • Take vitamin supplements particularly Vitamin B.

Get enough exercise
2 – 3 times a week do something that gets your heart rate up.
Exercise is crucial for removing stress products that accumulate in the body and lead to degenerative conditions like cardiac disease.

Avoid "stay awake" medications

Go to bed on time
Get at least 7 – 8 hours of sleep. Sleep is the tonic the body needs to operate at its optimum. Remember it is often the shortest bridge between despair and hope.

Get up on time so that you can start the day unrushed.

Write things down. Have pencil and paper next to your bed
If you suddenly think of something write it down so you can let it go and go back to sleep.

Be creative

Listen to relaxing music

Learn relaxation techniques
Meditation, yoga, visualisation and progressive muscle relaxation are powerful techniques that induce a sense of calm and relaxation.

Breathe deeply
Learn how to breathe properly. (Read how to do this under Short Term, On-the-Spot Exercises).

Everyday, find some quiet time alone

Spend time in nature
Nature has an amazing ability to restore peace and calm. It is also remarkably energising.

Be aware of Burnout
Try not to work yourself to the grave. Don't let your reservoir of life energy get so low that you don't have enough energy to do soul-nourishing things.
Read my article called Spurn The Burn for more information on Burnout.

Collect your favourite cartoons, watch comedies – Laugh
Laughter reduces stress. Humour is protective and immune enhancing. Laughter is superb medicine!

Laugh some more!

Severe Stress Experiences

Physical attacks (such as rape), serious accidents, close brushes with death (such as a violent hijacking) or even seeing someone else being killed or maimed, have a potentially debilitating effect on human effectiveness.

The effects of such severe stress experiences are not necessarily immediately apparent and a time lag may occur before the appearance of its effects. Post-Traumatic Stress Disorder (PTSD) involves disturbed behaviour that emerges sometime after a major traumatic event. It also occurs in the wake of disasters such as floods, earthquakes, fires and hurricanes.

Post-Traumatic Stress Disorder is caused by a single episode of extreme stress - rather than chronic, prolonged, everyday stress - and requires prompt professional intervention. 

For more information about PTSD refer to my article Tackle Trauma.