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Literature Review

Vol. 1 No. 2 (2025): Regular Issue

Psychosocial Stressors and Their Clinical Consequences

  • Battuvshin Lkhagvasuren
  • Tetsuya Hiramoto
Submitted
December 31, 2025
Published
December 31, 2025

Abstract

This review describes the origins, symptoms, and mechanisms of psychosocial stressors and compares these with symptoms induced by physical stressors. Diverse stressors can elicit symptoms that signal threats to homeostasis. Although physical and psychosocial pathways may differ in their afferent inputs, they can converge on shared efferent outputs. Recent advances suggest that identifying symptom origins helps link symptoms to relevant effector systems and guides treatment selection. Emerging bidirectional neuroimmune mechanisms, key moderators, and technological innovations further refine this framework, highlighting the need for personalized interventions to reduce disease chronicity. It is emphasized that identical symptoms may require different treatments depending on whether the triggering input is physical or psychosocial. Recognizing symptom origins is therefore essential to prevent diagnostic delay and avoid missed opportunities for timely care.

References

  1. Akbar, A., Yiangou, Y., Facer, P., et al. (2008). Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. *Gut, 57*(7), 923–929. https://doi.org/10.1136/gut.2007.138982 PMID: 18252749
  2. Al-Khatib, S. M., Stevenson, W. G., Ackerman, M. J., et al. (2018). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. *Circulation, 138*(13), e272–e391. https://doi.org/10.1161/CIR.0000000000000549 PMID: 29084731
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
  4. Ando, A., Smallwood, D., McMahon, M., et al. (2016). Neural correlates of cough hypersensitivity in humans: Evidence from functional brain imaging. Thorax, 71(4), 323–329. https://doi.org/10.1136/thoraxjnl-2015-207426 PMID: 26860344
  5. Archer, J., Bower, P., Gilbody, S., et al. (2012). Collaborative care for depression and anxiety problems. *Cochrane Database of Systematic Reviews*, (10), CD006525. https://doi.org/10.1002/14651858.CD006525.pub2 PMID: 23076952
  6. Barsky, A. J., Wyshak, G., & Klerman, G. L. (1988). The somatosensory amplification scale and its relationship to hypochondriasis. Psychosomatic Medicine, 50(5), 510–519. PMID: 3186894
  7. Benarroch, E. E. (1993). The central autonomic network: Functional organization, dysfunction, and perspective. Mayo Clinic Proceedings, 68(10), 988–1001. https://doi.org/10.1016/S0025-6196(12)62272-1 PMID: 8412366
  8. Blanchard, E. B., Lackner, J. M., Jaccard, J., et al. (2008). The role of stress in symptom exacerbation among irritable bowel syndrome patients. Journal of Psychosomatic Research, 64(2), 119–128. https://doi.org/10.1016/j.jpsychores.2007.10.010 PMID: 18222125
  9. Browning, K. N., & Travagli, R. A. (2014). Central nervous system control of gastrointestinal motility and secretion and modulation by stress. *Comprehensive Physiology, 4*(4), 1339–1368. https://doi.org/10.1002/cphy.c130055 PMID: 25428846
  10. Burton, C., Fink, P., Henningsen, P., et al. (2020). Functional somatic disorders: Discussion paper for a new common classification for research and clinical use. *BMC Medicine, 18*, 141. https://doi.org/10.1186/s12916-020-01600-2 PMID: 32423498
  11. Camilleri, M. (2004). Chronic diarrhea: A review on pathophysiology and management for the clinical gastroenterologist. Clinical Gastroenterology and Hepatology, 2(3), 198–206. https://doi.org/10.1016/S1542-3565(04)00003-5 PMID: 15017602
  12. Chalmers, J. A., Quintana, D. S., Abbott, M. J., et al. (2014). Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Frontiers in Psychiatry, 5, 80. https://doi.org/10.3389/fpsyt.2014.00080 PMID: 25071612
  13. Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470. https://doi.org/10.1016/0005-7967(86)90011-2 PMID: 3741311
  14. Clayburgh, D. R., Shen, L., & Turner, J. R. (2004). A porous defense: The leaky epithelial barrier in intestinal disease. *Laboratory Investigation, 84*(3), 282–291. https://doi.org/10.1038/labinvest.3700050 PMID: 14767487
  15. Critchley, H. D., Wiens, S., Rotshtein, P., et al. (2004). Neural systems supporting interoceptive awareness. *Nature Neuroscience, 7*(2), 189–195. https://doi.org/10.1038/nn1176 PMID: 14730305
  16. Dantzer, R., O'Connor, J. C., Freund, G. G., et al. (2008). From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46–56. https://doi.org/10.1038/nrn2297 PMID: 18073775
  17. Dicpinigaitis, P. V. (2003). Cough reflex sensitivity in cigarette smokers. Chest, 123(3), 685–688. https://doi.org/10.1378/chest.123.3.685 PMID: 12628863
  18. Doran, C. M., & Kinchin, I. (2019). A review of the economic impact of mental illness. Australian Health Review, 43(1), 43–48. https://doi.org/10.1071/AH16115 PMID: 29129189
  19. Drossman, D. A., & Hasler, W. L. (2016). Rome IV—Functional GI disorders: Disorders of gut–brain interaction. Gastroenterology, 150(6), 1257–1261. https://doi.org/10.1053/j.gastro.2016.03.035 PMID: 27147121
  20. Ehlers, A., & Breuer, P. (1992). Increased cardiac awareness in panic disorder. Journal of Abnormal Psychology, 101(3), 371–382. https://doi.org/10.1037//0021-843X.101.3.371 PMID: 1500594
  21. Furness, J. B. (2012). The enteric nervous system and neurogastroenterology. Nature Reviews Gastroenterology & Hepatology, 9(5), 286–294. https://doi.org/10.1038/nrgastro.2012.32 PMID: 22392290
  22. Henningsen, P., Zipfel, S., & Herzog, W. (2007). Management of functional somatic syndromes. The Lancet, 369(9560), 946–955. https://doi.org/10.1016/S0140-6736(07)60159-7 PMID: 17368156
  23. Hiramoto, T., & Lkhagvasuren, B. (2025). What is stress. Core Reports, 1(1), e2.1-13
  24. Kc, P., & Martin, R. J. (2010). Role of central neurotransmission and chemoreception on airway control. Respiratory Physiology & Neurobiology, 173(3), 213–222. https://doi.org/10.1016/j.resp.2010.03.020 PMID: 20359553
  25. Khalsa, S. S., Adolphs, R., Cameron, O. G., et al. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2018.04.007 PMID: 29884281
  26. Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. Annals of Internal Medicine, 138(11), 917–925. https://doi.org/10.7326/0003-4819-138-11-200306030-00007 PMID: 12779303
  27. Leech, J., Mazzone, S. B., Farrell, M. J., et al. (2013). Placebo-induced suppression of cough in healthy volunteers. American Journal of Respiratory and Critical Care Medicine, 188(9), 1069–1075. https://doi.org/10.1164/rccm.201306-1079OC PMID: 24093551
  28. Morice, A. H., Millqvist, E., Belvisi, M. G., et al. (2014). Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. European Respiratory Journal, 44(5), 1132–1148. https://doi.org/10.1183/09031936.00218613 PMID: 25142479
  29. Morice, A. H., Millqvist, E., Bieksiene, K., et al. (2020). ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. European Respiratory Journal, 55(1), 1901136. https://doi.org/10.1183/13993003.01136-2019 PMID: 31515408
  30. Morrison, S. F., & Nakamura, K. (2019). Central mechanisms for thermoregulation. Annual Review of Physiology, 81, 285–308. https://doi.org/10.1146/annurev-physiol-020518-114546 PMID: 30256726
  31. Nam, Y., Kim, Y., & Kim, H. (2018). Job stress and functional dyspepsia: A cross-sectional study using a large-scale health check-up data set. Annals of Occupational and Environmental Medicine, 30, 43. https://doi.org/10.1186/s40557-018-0251-4 PMID: 30364417
  32. Oka, T. (2015). Psychogenic fever: How psychological stress affects body temperature in the clinical population. *Temperature (Austin), 2*(3), 368–378. https://doi.org/10.1080/23328940.2015.1056907 PMID: 27227051
  33. Paulus, M. P., & Stein, M. B. (2006). An insular view of anxiety. Biological Psychiatry, 60(4), 383–387. https://doi.org/10.1016/j.biopsych.2006.03.042 PMID: 16780813
  34. Pavlov, V. A., & Tracey, K. J. (2012). The vagus nerve and the inflammatory reflex—Linking immunity and metabolism. *Nature Reviews Endocrinology, 8*(12), 743–754. https://doi.org/10.1038/nrendo.2012.189 PMID: 23169440
  35. Romanovsky, A. A. (2018). The thermoregulation system and how it works. In *Handbook of Clinical Neurology* (Vol. 156, pp. 3–43). Elsevier. https://doi.org/10.1016/B978-0-444-63912-7.00001-1 PMID: 30454596
  36. Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201–216. https://doi.org/10.1016/S0165-0327(00)00338-4 PMID: 11099742
  37. World Health Organization. (2019). ICD-11 clinical descriptions and diagnostic guidelines. World Health Organization.