What is Toxic Stress?

Principal image blog-post

We all experience stress at some times in our lives. And not all stress is bad for us. However, some kinds of stress can be overwhelming and dangerous, especially for developing bodies and brains.  

In particular, one form of stress, called toxic stress (or chronic stress) is capable of harming learning, behavior, and relationships. Toxic stress is different than coping with adversity, which can be a healthy part of growing up.

What is toxic stress? How can we recognize and treat it in behavioral health settings? 

3 Kinds of Stress

Harvard University’s Center on the Developing Child divides stress into three main categories: positive, tolerable, and toxic.

1. Positive stress response is a part of healthy development. We experience it in new situations, like starting a new school or job. Our bodies react by increasing our heart rates and our hormone levels are elevated.

2. Tolerable stress response is when our body reacts to a major difficulty: loss of a loved one, natural disaster, or injury. If it is a limited event and we are surrounded by caring adults and healthy relationships, the brain and body recover from the effects of this type of stress.

3. Toxic stress response is when someone experiences ongoing adversity like physical or emotional abuse, neglect, caregiver substance abuse, violence, or economic hardship and they don’t have adequate support from the adults in their lives. Their bodies and brains are in “fight or flight” mode so often that their development can be impaired, even as they grow up. 

The types of trauma that cause toxic stress are called adverse childhood experiences (ACEs). The more ACEs a young person experiences, the harder it is to reverse the damage done to developing brains and bodies. 

The ACEs Questionnaire

How do we know if a person has experienced trauma? 

The ACE Score Questionnaire is an assessment tool used by thousands of professional clinicians and researchers. It includes questions that help determine if someone was mistreated by an adult, whether abuse of others was occurring in the home, whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them. 

The negative outcomes of ACEs are numerous and continue across the lifespan, including injury, mental health conditions, maternal health concerns, infectious and chronic disease, risky behaviors, and missed opportunities in school and life.

According to the Centers for Disease Control (CDC), 61% of people report experiencing at least one type of adverse childhood experience (ACE) before age 18, with one in six experiencing four or more types of ACEs.

What Happens When Someone Experiences Toxic Stress?

When someone spends a lot of time experiencing toxic stress, their body responds to the perceived and actual threats by pumping out hormones like adrenaline and cortisol. Elevated cortisol levels cause a number of problems in the body, including delays in development.  And as people grow older, they are at a higher risk for depression, substance abuse, heart disease, and diabetes. 

Scientists are learning about the ways toxic stress affects different biological functions.

  • Brain. Toxic stress can make it difficult for people to sit still, pay attention, or learn. It can affect impulse control and behavior, and cause extremes in emotion.

  • Heart. Toxic stress increases the risk of developing high blood pressure and inflammation, causing damage to arteries. That makes people more vulnerable to heart conditions and strokes.

  • Immune system. People who live with toxic stress have trouble fighting off colds, ear infections, and other types of infections or conditions.

  • Hormones. Toxic stress can affect growth, development, and puberty. It also increases the risk of obesity. 

Signs of Toxic Stress

Choosing Therapy’s website lists the following signs of toxic stress:

  • Physical pain or discomfort like an upset stomach, headaches, or muscle aches

  • Increased heart rate or faster breathing

  • Trouble sleeping or having nightmares

  • Changes in eating or weight

  • Irritability, mood swings, anxiety, or depression

  • Impulsive or risky behavior

  • More use of alcohol or drugs

  • Trouble with concentration or memory

  • Lack of interest in activities or social interactions

  • Racing thoughts or negative self-talk

  • Dropping grades

  • Temper outbursts

  • Aggression

  • Self-injury

That’s a lot to unpack, and there are many possible triggers for toxic stress. But the important thing to remember is that behavioral health professionals can help people of all ages identify protective factors that can help them cope and recover from toxic stress.

There is no “magic bullet” cure for toxic stress, but strong, caring relationships with adults can help young people avoid the long-term effects of toxic stress response. 

For adults getting treatment for toxic stress and/or trauma, there are a number of treatments and approaches that can help.

Tools for Assessing Toxic Stress

Because toxic stress is not an official medical diagnosis, the best way to address it is to learn about risk factors and signs while also understanding the impact of trauma in individuals and communities. Here are a few places to get good information:

1. The ACEs questionnaire is always a good place to start. It can help us understand what someone has experienced and what their level of resilience is. 

2. Harvard’s Toxic Stress 101 page has a good explanation of toxic stress.

3. The American Institute of Stress has a free stress assessment.

4. The Connecticut Women’s Consortium has numerous behavioral health trainings on trauma, the ACEs, and other topics that can help address toxic stress in our practices and communities. 

How Can We Help?

Caregivers and behavioral health professionals can help by creating environments of safety and stability, especially for children who have experienced toxic stress. Some of the protective factors for people experiencing toxic stress include

  • Healthy food

  • Regular exercise

  • Quality sleep

  • Mindfulness techniques like meditation and yoga

  • Mental health support

  • Inpatient rehab or detox if substance abuse is involved

  • Medication for depression, anxiety, or other mental health conditions

  • Employee Assistance Programs that offer wellness benefits or counseling

  • Couples counseling, family counseling, or specialized therapy

  • Individual talk therapy or support group

Moving Past Fight or Flight

When behavioral health professionals are able to recognize and treat trauma and toxic stress in individuals and families, it creates a ripple effect. Less stress leads to increased resilience and healthier communities.


Download the Guide to Behavioral Health Training


Subscribe for updates