Stressed out by Finances? Maybe You're Suffering from Acute Financial Stress

Acute Financial Stress has many of the same symptoms as PTSD.

One potential consequence of economic stress is a kind of PTSD, which psychologist Galen Buckwalter has termed Acute Financial Stress via findings in his research on the topic. Over the past month, AlterNet has produced a series of articles on AFS by Buckwalter, which has led to some interesting and robust discussions in the AlterNet comments section.

To broaden understanding, AlterNet conducted an interview with Buckwalter via email, which goes into more depth on his findings on AFS. Insights include what types of people are most susceptible to AFS, how inequality can contribute to it, what kind of effects AFS has on the body, and what to do about it.  

AlterNet: Acute Financial Stress as a diagnosis comes as no surprise to people who are stressed about their finances. What’s the news here?

Galen Buckwalter: My research is about how stress about money is derailing people, leading to negative mental, physical and emotional health outcomes. Data at this level hasn’t been quantified before, and in the scientific community, data enables us to transform assumptions into action. That AFS comes as no surprise to so many people is evidence that so many people are experiencing stress at this level. Now that we’re quantifying it, we have a responsibility to address treatment for it. Understanding the cognitive processes is the first step.

AN: How is AFS different than simply being anxious about money?

GB: Anxiety that comes and goes seems to have none of the intensity of the symptoms nor the long-term consequences that we see associated with Acute Financial Stress. AFS, and the associated disorder of PTSD, seems to be one of those disorders that emerge when a certain stress threshold is crossed, which, once crossed, results in the emergence of a much more serious condition.

With average anxiety, one may worry about money when paying the bills, but then you start playing with your kids or you go for a jog, for example, and the feeling passes. However, with AFS, the stress is all-consuming both physically and emotionally. Perhaps most troublesome about AFS is the fact that a person’s basic cognitive processing patterns change: reason goes out the window, leaving one increasingly open to denying the reality of their own situation. Isolation, depression and shame set in. This state of cognitive distortion makes it all but impossible to do the hard work of changing the causes of stress.

When the cause of stress is as systematic and pervasive as financial inequality, we need to be able to bring all possible resources to the table—including an understanding of the psychological processes involved if we are ever going to have a chance to build the type of community required to change this deeply ingrained system.

AN: How can this lead to PTSD?

GB: In the case of AFS, this threshold of stress varies from person to person, with some people quite possibly having such a high tolerance for stress that they are basically immune to AFS or PTSD. But for many people, when their stress level reaches this threshold, a clearly diagnosable disorder is evident.

In AFS, as in PTSD, the disorder is manifest in three areas:

1. Thoughts become unrealistic: Denial and avoidance are evident in the person’s approach to finances, making it all the more difficult for the person to manage their stress,

2. Emotions become extremely changeable: One day the person seems flat and disengaged, the next they are super-irritable and outright hostile, and

3. The person feels consumed with the problem: Nothing else really matters in life; even their sleep is consumed with their stress, with recurring nightmares common. These people also feel hypervigilant, as if, if they relax for a moment, something really, really bad will happen.

AN: You came upon AFS after studying financial personality for two years. What role does personality play in who will experience AFS more acutely than others?

GB: I think it is accurate to think of personality as a fundamental organizing principle of the brain. Personality research has only recently come to a consensus of the universal dimensions of personality, defined as HEXACO (Humility/Honesty, Emotionality, Extraversion, Agreeableness, Conscientiousness, Openness).

These six dimensions are found in every group of people who have been analyzed thus far. Each of us think/believe/behave in relatively stable ways across all six dimensions. For example, my personality is most notable for a high level of Openness, which is closely related to curiosity. But I also score high on Humility/Honesty, which I suspect has something to do with the fact I was raised in a very humble farming community, and my father was a Mennonite preacher.

I encourage everyone to know their personality profile, because not knowing your personality puts you at a disadvantage when it comes to understanding yourself, your environment, your choices and the relationships you have with the people around you. In regard to AFS, given that our personality provides a framework by which we can understand our general approach to life, it stands to reason personality can tell us who may be either resilient or more prone to experience AFS.

We have seen strikingly similar results in research on well over 10,000 people. People high on Conscientiousness, for example, who we refer to as Architects (super organized, fit well into existing power structures and norms) are generally protected from AFS. Two other personality types are consistently at significantly lower risk for AFS: Those low on Emotionality, whom we label Rocks (stoic, emotionally restrained, unflappable types) and people low on Openness, termed Guardians (traditionalists, those most comfortable with what they already know and have little desire to push the envelope) seem to be well protected by virtue of their core personality traits.

Some personality types who have the most difficulty with financial management in general have the highest levels of AFS and are at extreme risk. These are those high on Emotionality, whom we refer to as Sparks (dramatic, emotional and highly sensitive) and those low on Conscientiousness, or Free Spirits. These folks prefer chaos to organization and anarchy to capitalism. Balanced checkbooks and striving to get in the exclusive Platinum clubs of the world just don’t compute for most people with these personality traits, as their values lie elsewhere.

AN: Tell us about stress and how it works, as well as what this means in terms of inequality.

GB: Inequality is undoubtedly a major cause of AFS that cannot be overlooked and underestimated. The human spirit is amazingly resilient, but an empty larder, or the realistic threat of an empty larder, is beyond our ken. We cannot withstand constant threats to survival, which is what poverty is at its core.

The focus of the psychological community is by definition on the individual and what she can do to function in and experience her environment in a positive way. It’s not a matter of teaching her to accept an intolerable situation; rather, it is helping her to get to a place where she will be able to live the most emotionally stable life. So, if she is buffeted by the vagaries of inequality, our goal is to give her tools to be able to function most effectively as a person. If you approach the task of trying to change the world with an emotional and cognitive status that is completely reactive to the stress of your environment, it’s going to be an extremely difficult uphill battle.

But if you avail yourself of the information widely accepted among a multidisciplinary group of scientists on the effects of stress and how one can alter one’s response the next time a stressor hits, you individually, not dependent on anyone else or any other group, can control your reaction to stress, thus allowing you to respond thoughtfully and with access to all regions of your brain.

Otherwise, you will react with the brain of a person in a flat-out sprint across the prehistoric plains of our ancestors with a hungry lion stalking us. That is not the state we want to be in if we are going to change the world and convince the powers that be to relinquish their stranglehold on the economic resources needed for everyone to live a meaningful life.

Dismissing this validated science on how stress alters the brain out of hand has all the credibility of refusing to consider climate change because it still snows.

AN: Why is it critical to health to understand our stress responses?

GB: Obviously, people can deal with the exact same stressors in very different ways; indeed, the same person can deal with the same stressor very differently under different circumstances. We can, however, alter our response to any stress in a positive way, thereby improving our entire lives. In the case of AFS, this doesn’t mean making more money magically appear, but rather understanding our stress responses on a granular level so we can begin the process of changing how we react.

Stress is an expression of hormonal changes in the body. Any perceived stressful event, including but not limited to physical threats to our beings, evokes one of the most dramatic orchestrations of biological changes our bodies ever experience. Hormones—including those that result in stress—are prone to change, often exponentially. Provided a threat that produces stress resolves relatively quickly and without trauma, it’s basically no harm to us. In fact, this jolt to the system can strengthen our bodies. Cheetahs, for example, don’t suffer from stress-related disorders. Their lives are such that they experience times of full-on stress when they are hunting or when their territory is infringed upon. But the key we can learn from them is that when they go back to their lairs, they don’t appear to be worrying if they are going to be able to find food tomorrow. Our big brains keep most of us thinking about what tomorrow will bring and how we will pay for it.

The story of chronic stress has been understood from repeated observations among soldiers and marines. When persons are in conditions where stress does not resolve, a sizable proportion of people are unable to—or maybe they just don’t know how to—get their systems back to baseline when experiencing chronic stress. But even with the horrific stressors of war, most people do not have unmanageable levels of stress during the time they are exposed to chronic stress, nor do they have long-term dysfunctions.

AN: How does stress work in the body? Is there something unique about financial stress that is different than other kinds of stress?

GB: We honestly don’t know the effect of different types of stress on the body and mind, which both perceive stress as a monolithic thing regardless of what is causing it, which is why AFS is so important to understand.

The often-criticized DSM-V recently added the proviso that you can’t be diagnosed with PTSD unless you have experienced a life-threatening event, or a “qualifying event.” I disagree. If you consider the symptoms clusters that define PTSD—disordered thoughts (constantly reliving the stressors, nightmares common), emotions (feeling flat emotionally, unable to enjoy life, particularly relationships) and feelings (hypervigilance, always feeling on overdrive)—AFS fits neatly into this diagnosis. In our research, we find anywhere from 18 percent to 24 percent of Americans report the cluster of symptoms that are associated with PTSD.

A clinician following the DSM-V like a bible might argue that what we have termed as Acute Financial Stress differs from PTSD in that there is usually no qualifying event, that being an extremely physically threatening event. I strenuously disagree, and this hair-splitting makes little sense to me. If a person is having nightmares, driving loved ones away and unable to think clearly, I don’t see why it matters if it started because the patient was attacked or they feel existentially threatened because they can’t pay their bills.

I believe there needs to be a lot more research on the severity of the symptoms that occur in AFS versus PTSD, but I’m convinced that the clusters of symptoms seen in both disorders are identical. And if the end results are the same, I think we should consider them on an equal par in deciding how we proceed with treatment and prevention.

AN: Your research has zeroed in on how financial stress is one of the triggers leading to emotional, mental and physical illness. Can you talk about some of the data you’ve uncovered?

GB: I think the most profound finding from our research is the association we see between AFS and chronic medical conditions. As is apparent in the research paper, those with AFS have higher proportions of almost all the conditions we asked about, most notably all of the autoimmune conditions. Of course, correlation does not equal causation, so we don’t know if the stress leads to the medical condition or the medical conditions cause the financial stress. There are certainly plausible hypotheses for either direction, but there are also ways to collect better data to tease out the chicken and the egg, and that is where our future research is focused.

AN: What happens to the body and mind after prolonged periods of stress, regardless of where the stress comes from?

GB: The fit between a person and the circumstances of their life and the biological mediators that facilitate this fit has long been an area of study amongst psychologists, biologists as well as the occasional economist. This interface is almost uniformly conceptualized by researchers as stress despite the myriad of psychosocial, environmental, physical and other environmental variations that people may confront.  

The brilliant molecular biologist Bruce McEwen argued it is inappropriate to refer to every human reaction to an environmental or psychosocial event as stress. Relying on the work Sterling and Eyer conducted on the cardiovascular system, McEwen adapted the term ‘allostasis’ to refer to any physiological system that needs to maintain stability in the presence of recurrent change induced by external events. While Sterling and Eyer identified cardiovascular patterns dependent on the specific activational state of the body, McEwen expanded this to other psychophysiological mediators, such as cortisol and catecholamines. The process to be understood in allostasis is a period of reactivity followed by a time of recovery with eventual return to baseline.

In addition to expanding the notion of allostasis to include all reactive physiological systems, McEwen also introduced the notion of allostatic load (AL) to indicate the wear and tear that is inevitable either after innumerable cycles of allostasis or when there were disorders of allostasis, such as ineffective activation or termination events, meaning: the stress never goes away. Allostatic load follows a basic trajectory of distress (intense short-term or chronic stress) that then causes any of the key allostatic systems in the body (e.g., blood pressure, cardiovascular, metabolic, inflammatory, etc.) to remain (more or less) in a state of dysregulation. This dysregulation, particularly when chronic, can lead to significant damage to these and related biological and psychological systems, and in turn, leads to significant negative health outcomes including diabetes, heart disease, cancer, depression, alcoholism and post-traumatic stress disorder.

This provocative model for the development of chronic diseases provides a plausible explanation for the fact that in the midst of some of the most remarkable medical advances ever, the 20th century also marks the emergence of chronic diseases with non-communicable conditions accounting for nearly two-thirds of deaths worldwide. In the U.S., chronic diseases are the main causes of poor health, disability and death and account for most of health-care expenditures. This epidemiological transition, the third after the Age of Pestilence and Famine and the Age of Pandemics is widely called the Age of Chronic Diseases. In other words: stress damages our bodies and minds and shortens our lives.

While our current focus is on AFS as the causative risk factor to interrupt, and progressively degrade, allostasis, we feel the dynamic process underlying allostatic load will be similar across different stressors.

AN: What words of advice would you offer to people who feel stress of the kind you study?

GB: The thing that stands out to me time and time again in doing this research is the sense of abject despair that people feel. As someone who was thrown a massive curveball in my own life, I’m intimately acquainted with despair. I’ve learned there are little things that we can do that may not seem to make a difference in the moment, but with some consistency, they have the power to alter how we experience stress, despair and our lives in general. Central to this is hope and gratitude.

My stressor, as it were, is the fact I broke my neck as a young and dumb teenager and have been paralyzed from the chest down since. I mention this because almost if not everyone I was in the hospital with back then is long dead. Having a spinal cord injury puts you at the top of the list for such stress-related conditions as suicide. But in reality, I am happy as a clam at age 60, and it’s not because my stress has diminished. In fact, as an old fart, the pain and level of dependence I experience worsens every year.

But after spending much of my life depressed, self-medicated and miserable, a number of events happened—some out of my control but many that I initiated that have given me a stress-fighting ability that is such that what I did may have some relevance to others seeking to banish stress at high levels.

AN: What can people do to combat extreme stress of the kind you study?

GB: Here’s what I did, and I’m not suggesting that this is like flipping a switch. First, I found a positive relationship. Someone who has my back, who meshes with me and whom I want to do right by, every day. I don’t think I have to stress the importance of a good relationship; I simply wish there were better, more affordable ways that would help people find good mates. In this aspect, I’ll forever admit that I got lucky and life blessed me profoundly. My work studying compatibility led to the matching tools used by eHarmony, so again: knowing more about your personality is truly at the heart of knowing who you may have a successful relationship with. Connections really do change how we view our lives and the world, which is part of why AFS is so dangerous: It isolates people, leading to depression and fewer connections. Social support really does matter, as we weren’t meant to go through life alone.

But the next part happened entirely through my initiation and effort. After diving into all the literature on stress and, more importantly, into the work on resilience, which I think is best defined as doing the things that best strengthen us for the inevitable next round of stress, I started trying to use my mind to reconceptualize the things that have traditionally driven me nuts about being disabled.

First, I addressed the ton of mind-numbing repetitive tasks I have to do just to freaking live. For example, it takes me about 10-15 minutes to transfer myself into my seat in a van, get positioned and strapped in so I can drive safely and get all my podcasts and books set to listen on the drive. I decided to see if instead of letting that time drive me crazy and make my whole day miserable, I would use that time to think about what was good in my life, who had been nice to me recently, what I could do to bring people I loved something good. Nothing dramatic happened, but I suppose enough occurred in the back of my mind for me to stick to it because I am still doing it some 10 years later. If you were to ask me to rate my ability to manage the stress of my disability, my mood, even my sense of meaning and purpose in life, there has been a sea change from over the last decade. Now my stress is in the background, my life is foreground, which is a staggering change for me.

The whole notion of using our thoughts as a way to jump-start feeling better is likely the most used technique in clinical psychology since the '60s. The refinement of traditional cognitive behavioral therapy to one that directly attempts to use our thoughts as a way to build resilience toward stress is newer and not as well researched. But the research that is there is extremely compelling.

Foremost among the techniques that have shown an amazing ability to start to change our stress response cycle is the simple concept of gratitude. Think about gratitude on a simple human level. If we are grateful, others tend to respond in kind. If we are grateful, our mind has time to muster all our resources, to calm our emotions and to plan for change in an effective way.

The ability to use gratitude and even meditation to focus our thinking is essential to why I think this technique makes sense even in situations where the cause of our stress is external, as it is with AFS. Changing financial inequality is a staggering task. We are not going to be able to act effectively as a community if we are all thinking with a stress-addled brain. But if the first step we all take is to shift our primary cognitive state to one of gratitude and focus, we will all be able to approach the task of change more effectively. And we have the additional side effect of feeling better, of enjoying our relationships, of enjoying the amazing world we are blessed to inhabit.

I bring this up in the hope that some of you might think of how you can start to feel a bit more positive about the things that stress you out the most. Don’t expect to magically change how you feel in the face of chronic stress, but rather simply find predictable times in your day when you are by yourself, when it is easy for your thoughts to go to the financial stuff that is eating you up, and instead use that time to reflect on what you are grateful for. It takes some practice and discipline but has been proven to impact the mind. What do you have to lose?

Next up in the series, please take a look at some of the stress reduction techniques outlined by my colleague, clinical psychologist Dr. Ryan Howes.

Don Hazen is the executive editor of AlterNet.

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