Toxic Stress

What is toxic stress?

When a person encounters a challenge, problem, or threat, there may be a stress response—stress hormones trigger a cascade of physiological changes in systems throughout the person’s body. Occasional and brief stress responses are a normal part of healthy development. However, stress that is prolonged, severe, or chronic, can cause significant problems with health and development. (Franke, 2014). Such stress, that itself creates additional challenges for a person’s functioning, is toxic stress (Harvard University Center for the Developing Child, n.d.).

Among the stressors that are likely to cause adverse reactions are potentially traumatic events like exposure to violence (especially recurring violence such as child abuse or domestic violence, or threats of violence in neighborhoods with high rates of violent crime); and experiences of war, terrorism, or natural disasters. Even chronic stressors like low-income families’ insecurity about basic needs such as housing, food, home energy, or medicines, though not traumatic, may be associated with problems in functioning (Hamoudi, Murray, Sorensen and Fontaine, 2015).

Toxic stress can increase health risks including heart disease, mental illnesses such as depression and anxiety disorders, substance misuse, and has long-lasting negative consequences for cognitive functioning, behavioral health, immune functioning, and physical health. (Hamoudi, et al, 2015). Additionally, although the research is ongoing, there is some evidence that toxic stress in children and adolescents may make it more difficult for youth to learn effective self-regulation, posing challenges for educational, occupational, and relationship development into adulthood. (Murray, Rosanbalm, Christopoulos and Hamoudi, 2015).

Why the Concept of Toxic Stress is Important for Human Services Agencies

Toxic stress is a factor in the lives of many or most of the people served by human services programs. The stressors that can lead to prolonged or severe stress reactions are often linked to the social and economic disadvantages that human services programs are designed to address. In addition, many human services programs serve clients with reduced access to strong family or community support.

Many of the populations served by human services programs are at increased risk of toxic stress. These include children and youth in the child welfare and foster care systems; survivors of domestic violence or human trafficking; refugees; people with disabilities; and individuals and families experiencing homelessness, food or energy insecurity, or other severe economic hardship. Therefore, human services programs are well-positioned to intervene in the patterns that lead to toxic stress. Human services programs can create change in conditions that trigger severe, chronic stress, like economic insecurity and threats to personal safety, and human services programs can also help to link children, youth, and families with stronger sources of social and emotional support.

Relevant Interventions and Approaches

Trauma-informed approaches in human services programs can help clients who may be experiencing toxic stress. Trauma-informed human services can help programs avoid creating additional stress for clients, or re-traumatizing them. Trauma-informed human services can reduce the burden on clients to participate in services, and may foster supports that can be beneficial in mitigating toxic stress. Some clients may additionally require referral to clinical mental health services for stress- or trauma-related issues.

Toxic stress may be acute, cumulative, or chronic. Individual stressors do not have to be actually traumatic to create toxic stress; long-term severe stress may be harmful even without acute traumatic events. Toxic stress and trauma may occur together.

Different stressors affect individuals differently, and the causes of resilience—what makes some people experience severe, chronic stressors without long-term problems—is still not well understood. There is some evidence that social and emotional support, such as consistent parenting for young children, or family and peer community supports for adolescents and adults, may mitigate stress-related harms.

Resources for Further Learning


  • Franke, H. A. (2014). Toxic Stress: Effects, Prevention and Treatment. Children, 2014, 1, 390-402.
  • Hamoudi, Amar, Murray, Desiree W., Sorensen, L., & Fontaine, A. (2015). Self-Regulation and Toxic Stress: A Review of Ecological, Biological, and Developmental Studies of Self-Regulation and Stress. OPRE Report # 2015-30, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
  • Harvard University, Center on the Developing Child (n.d.) Key Concepts: Toxic Stress. Accessed November 29, 2016 at: Visit disclaimer page
  • Murray, Desiree W., Rosanbalm, Katie, Christopoulos, Christina, and Hamoudi, Amar (2015). Self-Regulation and Toxic Stress: Foundations for Understanding Self-Regulation from an Applied Developmental Perspective. OPRE Report #2015-21, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

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