Signs of Distress

It is important to note that any single symptom by itself may not indicate the presence of unmanageable stress. Assessment involves the total picture of the individual’s functioning. Look for combinations of symptoms, overall patterns.


  • in sleep patterns (insomnia or extreme sleepiness, nightmares)
  • in appetite (overeating or loss of appetite)
  • in weight (notable gain or loss)
  • in energy level (hyperactivity or exhaustion)
  • in mood (more irritable, more excitable, or more depressed)
  • in performance or activity (compulsive, erratic, or diminished)
  • in personal appearance (lapse in grooming or hygiene)

Physical Complaints of Unknown Origin

  • headaches, skeletal pain, gastrointestinal disturbances, cardiovascular problems, frequent illness or accidental injury, dizziness, extreme weakness


  • from activities and social interaction
  • from emotional involvement with others
  • from academic work and classroom participation

Emotional Overreaction

  • spells of crying
  • hypersensitivity
  • outbursts of anger inappropriate to the situation
  • violent behavior


  • reckless driving
  • excessive risk-taking
  • sexual acting-out
  • general impulsivity

Substance Abuse

  • overuse or regular use of illicit drugs, alcohol, and/or medication (without medical monitoring)


  • inability to concentrate or focus
  • persistent memory lapses
  • restlessness
  • preoccupation


  • sense of pessimism and helplessness
  • feeling out of control
  • anxiety
  • self-preoccupation
  • negative self-evaluation
  • references to suicide

Poor Contact with Reality

  • irrational conversation
  • obsessional ruminations or worrying
  • exaggerated suspiciousness or fear
  • apparent distortions of reality (auditory or visual hallucinations, inability to distinguish fantasy from reality), disorientation

Inappropriate Behavior

  • behavior inappropriate to the setting or situation
  • dangerous or threatening (to self or others) behaviors
  • bizarre or strange behaviors
  • antisocial acts (stealing, forcible sex, illegal pursuits)


  • panic feelings
  • physical shakiness
  • obsessive and ruminating thoughts
  • rapid heart rate
  • shortness of breath