Fig. 1.

Illustrative Clinical Manifestations of Mental Stress. Biologic stress can be physical and/or mental. Mental stress can influence behavior and affect psychological well-being. Many adaptive responses to acute stress are favorable towards enhancing survival. (i.e., ”fight or flight”). Conversely, chronic mental stress (i.e., “submit and stay”) is generally unfavorable and may increase allostatic load involving biologic alterations that weaken stress-related adaptive processes and increase susceptibility to disease [4]. Mental stress can promote changes in sleep, cognition, and perception of pain. Finally, beyond the contribution to obesity, mental stress can contribute to adverse physiologic changes in body systems, via generation of reactive oxygen species, as well as acute and chronic effects upon the endocrine and immune systems, potentially resulting in alterations in cardiopulmonary function, metabolic processes, increased risk of inflammatory diseases [5], cardiovascular disease [6,7], and cancer [7,8] (See Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6).