Mind Matters: Five signs that someone you know may not be coping well with stress

Stress is part and parcel of our lives. This may seem very discouraging as the word ‘stress’ itself automatically brings on negative connotations. However, it is indeed a natural and a very necessary reaction to our life experiences where it can bring about excitement, motivation and helps us rise to life’s challenges.

While some people respond well to stress, some may have significant difficulty coping with it. This is not just dependent on one’s coping skills. Some individuals are in difficult circumstances that may not be easily understood, some struggle with everyday events due to marked anxiety and some may have underlying mental illnesses that may be undiagnosed or not obvious to others.

Stress itself may precipitate mental illnesses as well. Mental illness in the form of depression, anxiety, obsessive compulsive disorders, eating disorders and psychosis can present in adolescence or early adulthood and may explain why someone appears to be struggling.

When the difficulty coping with stress is so significant, it has a substantial impact on one’s life and makes everything seem insurmountable. What is concerning is that some do not recognise that they need to seek help or do not dare to do so out of fear of being judged and end up struggling with their difficulties alone until they decompensate.

Here are five signs that someone you know may not be coping well with stress and may need some extra help.

A change in behaviour is a cause for concern and may have various causes. Someone who is known to be more socially active may become socially withdrawn when their mood is low. This may be due to depression, which can cause a loss of interest in activities or a lack of confidence in one’s self.

It may also be related to anxiety in social situations, resulting in avoidant behaviour. Keeping to themselves may amplify the sense of loneliness and the feelings that no one else understands what they are going through or reinforce the avoidant behaviour.

Though it is less common, withdrawal from social interactions when related to paranoid thoughts may be a sign of psychosis. You may notice this change in behaviour not just at large gatherings but at any opportunity for social interaction or the lack thereof.

Problems with learning or working may also be a sign of difficulty coping. People with depression or anxiety may have difficulties with concentration and may take longer than usual to complete a task.

They may also experience low energy levels and fatigue that will affect their ability to cope with the usual learning or work demands. A combination of these difficulties can result in frequent absenteeism from work or school.

Stress has a physiological impact on the body and high levels of stress can affect multiple systems causing symptoms such as palpitations, raised blood pressure, dry mouth and more. While these symptoms are usually transient, there are some concerns about the impact of chronic stress on one’s body.

When stress causes intense anxiety, it can lead to panic attacks as well. If you know of someone who has recurrent panic attacks, it is a sign that they may be struggling with anxiety or depressive disorders.

There may also be physical (also known as somatic) symptoms (e.g. headache, giddiness, abdominal pain) at times whereby an underlying pathology cannot be found. While many people may have transient symptoms in relation to a stressful event (e.g. tummy upset before a presentation), these symptoms can be impairing when they result in excessive thoughts, feelings and behaviours.

They are thought to be the body’s way of expressing psychological distress and are common in young children and adolescents who may not even recognise that they are under stress. Their excessive preoccupation with somatic symptoms can result in increased presentations to the doctors for many investigations, and school or work absenteeism.

You may find it difficult to talk to someone who has negative thoughts or excessive worrying or fears. People with depression or anxiety may struggle with cognitive distortions whereby they have unhelpful thinking patterns or irrational thought processes that they are not able to recognise.

It may be hard to reassure or reason with them when they are stuck in this negative pattern of thinking and are unable to see any alternatives suggested. These patterns of thinking can be so crippling such that one is weighed down with feelings of guilt or worries of failure until they are no longer able to carry on with their usual activities.

People who are struggling may resort to self-harm at times as an expression of their emotional conflict, to somehow help relieve their psychological distress or as a cry for help.  For some, the negative thoughts can be so overwhelming that they contemplate suicidal thoughts as they do not see any way out or a reason to live on.

Withdrawal from friends and family, ‘last acts’ by saying goodbye for no reason, giving away possessions are signs of suicidal behaviours and professional help should be sought as quickly as possible.

If someone you know displays the signs mentioned above, approach them to see if they need emotional support or practical help. Small gestures can go a long way in supporting them.

If you are concerned that they need professional help, do suggest resources that you are aware of and support them in the process of doing so.

Sometimes they may not feel ready and may feel very uncertain about seeking help. If you are increasingly concerned but not sure what to do, you may want to consider bringing up in a sensitive manner to their family member or a teacher/counsellor if you are in a school setting, or a supervisor if you are at work.

Dr Seet Xian Ying is a consultant with the Department of Psychiatry at Tan Tock Seng Hospital. She has interests in Consultation Liaison and General Psychiatry.

Where to get help:

– Samaritans of Singapore (24 hours): 1767
– Institute of Mental Health (24 hours): 6389 2222
– Singapore Association for Mental Health (Adults): 1800 283 7019 (Mon to Fri, 9am to 6pm)
– TOUCHline (Youth): 1800 377 2252 (Mon to Fri, 9am to 6pm)
– Care Corner (Mandarin hotline): 1800 3535 800 (Daily, 10am to 10pm)

For more mental well-being resources, check out Youthopia’s resource page with everything from mental health self-assessments to tips for coping with challenging seasons in life.

Other articles in this Mind Matters series:

How to broach the topic of mental well-being with your loved ones
Five ways to better manage stress while alternating between working from home and the office
Mind Matters: Five tips to manage exam stress during the COVID-19 pandemic