Everything from an unpredictable economy to family debacles, challenges at work and personal growth can cause stress. The response is mostly mediated by the hormones of the adrenal glands. The perception and length of stressors as well as the pre-existing state of stress and health can all influence the diversity and severity of the symptoms of the adrenal gland response and the exhaustion that can ensue over time. The three stages of adrenal exhaustion are classified as alarm, resistance and exhaustion, and the symptoms that evolve are representative of the hormonal changes that occur over time.
Identification
Adrenal exhaustion is a progressive scenario, occurring over many weeks to months and journeying through stages and presenting with stage-associated symptoms. Merriam-Webster.com describes the stages of adrenal exhaustion by the term "general adaptation syndrome." This name was coined in the 1950s by the famed endocrinologist Hans Selye.
Fight-or-Flight Response
The alarm stage of adrenal exhaustion is the stage that many people find themselves in during a stressful event. According to the Pan American Health Organization website, stressors that evoke symptoms of emotional exhilaration or arousal provide an increase in the normal fight-or-flight response. The fight-or-flight response mediates these symptoms when large amounts of acute stress hormones such as adrenaline are released. While PAHO notes that adrenaline is increased, Peter Wisniewski, author of the "Adrenal Recovery Support Guide," notes that longer-term, more influential hormones, such as cortisol and DHEA, are not drastically changed. The response during the alarm stage allows a person to run all day long, skip meals and even appear to feel more productive than normal, according to PAHO.
Systemic Changes
The resistance stage is also known as the adaptive stage. Symptoms of this stage result from the body's attempt to conserve its responses as it recovers from the alarm phase. These symptoms are listed by PAHO as a low energy reserve, social withdrawal, absenteeism, poor performance and tardiness. These symptoms often manifest after the stressor has been removed, as the body regroups and heals itself.
PAHO notes, however, that persistent and unrelenting stress in this stage will cause the body to adapt to a new level of stress as internal organs become resistant to the previous levels of stress. Wisniewski further notes that the level of cortisol will continue to rise, as its countering hormone, DHEA, begins to decline. During the resistance stage, the fluctuation of cortisol and DHEA levels leads to systemic changes and may result in symptoms such as anxiety, panic attacks and high blood pressure.
Exhaustion/Burnout
The exhaustion stage is the last stage of adrenal fatigue. It is also termed the burnout phase, according to PAHO. Complete depletion is experienced in this phase. PAHO lists warning signs and symptoms as feelings of depression, marked impairment in the ability to function socially and occupationally, and the potential for suicidal or homicidal thoughts. PAHO notes that the exhaustion phase occurs as a result of chronic, prolonged stress, whereby the person is in the alarm stage for too long and effectively skipped the recovery response of the adaptive stage. It is also noted to occur when a person experiences too many back-to-back stressors, cycling through the alarm and resistances stages all too often.
As the reserves or ability to adapt to the stressors at hand have been severely compromised, other symptoms such as a feeling of constantly being stressed, insurmountable fatigue and exhaustion will set in. This phase of the general adaptation syndrome is also likened to the clinical diagnosis known as adrenal insufficiency, or Addison's disease.
The hormonal changes during this phase are marked by very low levels of cortisol and DHEA. Wisniewski notes that abnormally low blood pressure can result and other symptoms such as chronic pain and immune system deficiency will begin to take on other diagnoses, such as fibromyalgia and chronic fatigue syndrome.
Treatment Expectations
The purpose of the alarm phase is to get you over or through the stressful event and back to normal functioning, once the event has passed. It is a protective and helpful response when it does not persist longer than needed. However, when a person stays in this phase for too long and it is tested and caught before moving into the exhaustion phase, treatment can include vitamin and mineral therapy; herbs; and relaxation therapies like deep breathing, yoga, meditation and rest. Wisniewski notes that the alarm stage can potentially be reversed with one to three months of treatment.
Progression into further stages will require prolonged treatment and possible medical intervention to deal with the systemic changes that occur. Six to nine months of treatment may be required to recover from the resistance stage and even longer treatment of 12 to 18 months may be needed to reverse the dramatic changes of the exhaustion phase, according to Wisniewski.
References
- Merriam-Webster: Definition of General Adaptation Syndrome
- Pan American Health Organization: The Stress Response
- "Adrenal Recovery Support Guide"; Peter J. Wisniewski; 2009
- MedlinePlus: Stress
