I've long known that my stress level is reflected in my skin. Oftentimes, after I start wondering whether some new pimples on my face are being caused by a hormonal glitch or maybe some new cosmetic, I'll remember to pause and consider how my life's been going.

That's when I realize that — thanks to a maddening combination of fatigue and insomnia that makes working and parenting extra challenging — stress is what is really causing my pimples. I doubt that I'm the only one who tunes into the physical signs that stress is upsetting my body.

In fact, this past weekend, I was on call for my physician group and received 2 remarkably similar calls, both of which I'll bet were related to the stress of anticipating a new school year.

Both of these callers have already been diagnosed with irritable bowel syndrome, yet both complained that they had more severe, cramping, abdominal pain than at any time before. After running a bunch of questions by each caller, I speculated that nothing too serious was going on (except for their misery!), apart from a physical symptom caused by the stress they were internally enduring.

These phone calls made me wonder how many other women out there are suffering from serious physical symptoms, never suspecting that their state of mind and lifestyle could be contributing to their ordeals.

And if it's a challenge for the sufferer to notice and admit that stress could be causing some tormenting physical symptom — just imagine how much more difficult it is for many doctors to acknowledge this mind-body connection.

A doctor making a diagnosis is obligated to consider all disease possibilities, especially the scariest and most life- or health-threatening. Only after all appropriate tests and evaluations have failed to turn up a medical cause can the physician resort to a diagnosis of idiopathic symptoms — those that cannot be attributed to any known physical cause. Only then can the symptoms be chalked up to stress or to some other mental manifestation.

The most common disorders caused by stress in our bodies include:

• mood disorders (like anxiety and depression)
• abdominal pain
• headaches
• muscular aches
• fatigue

Other symptoms sometimes triggered by stress include

• palpitations
• elevated blood pressure
• the repeated return of illnesses like yeast infections or head colds

Sure, there are a number of medical conditions that may contribute to all the symptoms listed above, and of course your doctor will work hard to evaluate those physical possibilities when you go to clinic, but the burden of showing that stressors are exacerbating your disorder will likely fall on your shoulders.

When should you start considering that stress may be a possible cause of disease?

• When you have multiple physical symptoms that cannot be attributed to a common ailment
• When you note that these symptoms improve during times when you are relaxed, e.g., early in a vacation.
• When you are feeling anxious about or discontented with one or more aspects of your life-work, home, school, and so on.

Next, how do you nail down an association between stress and your symptoms?

1. Keep a diary, preferably a calendar-type diary, to mark when symptoms occur.
2. Monitor their frequency and note whenever the symptoms correlate with life events.
3. Note the severity of symptoms by using a scale of 0-10, with 0 being no symptom present and 10 being the most severe you can imagine.

Your doctor can review this diary with you and help you see connections between events, or else can point you to other factors to look out for. Once you make connections between stressful events in your life and some of the symptoms you are experiencing, you can then work to reduce your stress or consider using techniques like biofeedback to minimize its impact on your physical well-being.